Kona Community Hospital

All Charges

Charge

Type

Setting

Price

MALIGNANT BREAST DISORDERS WITH CC

Facility

$52,866.65

Service Code	MSDRG 598
Min. Negotiated Rate	$14,879.72
Max. Negotiated Rate	$52,866.65
Rate for Payer: AlohaCare Medicare	$14,879.72
Rate for Payer: Devoted Health Medicare	$16,367.69
Rate for Payer: Hawaii Medical Service Association Commercial	$52,866.65
Rate for Payer: Hawaii Medical Service Association Medicare	$14,879.72
Rate for Payer: Humana Medicare	$14,879.72
Rate for Payer: Kaiser Permanente Commercial	$19,514.92
Rate for Payer: Kaiser Permanente Medicare	$14,879.72
Rate for Payer: Ohana Health Plan Medicare	$14,879.72
Rate for Payer: UnitedHealthcare Medicare	$14,879.72

MALIGNANT BREAST DISORDERS WITH MCC

Facility

$52,866.65

Service Code	MSDRG 597
Min. Negotiated Rate	$21,926.97
Max. Negotiated Rate	$52,866.65
Rate for Payer: AlohaCare Medicare	$21,926.97
Rate for Payer: Devoted Health Medicare	$24,119.67
Rate for Payer: Hawaii Medical Service Association Commercial	$52,866.65
Rate for Payer: Hawaii Medical Service Association Medicare	$21,926.97
Rate for Payer: Humana Medicare	$21,926.97
Rate for Payer: Kaiser Permanente Commercial	$28,757.47
Rate for Payer: Kaiser Permanente Medicare	$21,926.97
Rate for Payer: Ohana Health Plan Medicare	$21,926.97
Rate for Payer: UnitedHealthcare Medicare	$21,926.97

MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$12,647.70

Service Code	MSDRG 599
Min. Negotiated Rate	$1,783.92
Max. Negotiated Rate	$12,647.70
Rate for Payer: AlohaCare Medicare	$10,119.73
Rate for Payer: Devoted Health Medicare	$11,131.70
Rate for Payer: Hawaii Medical Service Association Commercial	$1,783.92
Rate for Payer: Hawaii Medical Service Association Medicare	$10,119.73
Rate for Payer: Humana Medicare	$10,119.73
Rate for Payer: Kaiser Permanente Commercial	$12,647.70
Rate for Payer: Kaiser Permanente Medicare	$10,119.73
Rate for Payer: Ohana Health Plan Medicare	$10,119.73
Rate for Payer: UnitedHealthcare Medicare	$10,119.73

MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS

Facility

$2,368.27

Service Code	APR-DRG 4211
Min. Negotiated Rate	$2,368.27
Max. Negotiated Rate	$2,368.27
Rate for Payer: AlohaCare Medicaid	$2,368.27
Rate for Payer: Hawaii Medical Service Association ABD	$2,368.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,368.27
Rate for Payer: Kaiser Permanente Medicaid	$2,368.27
Rate for Payer: Ohana Health Plan Medicaid	$2,368.27
Rate for Payer: UnitedHealthcare Medicaid	$2,368.27

MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS

Facility

$4,848.62

Service Code	APR-DRG 4213
Min. Negotiated Rate	$4,848.62
Max. Negotiated Rate	$4,848.62
Rate for Payer: AlohaCare Medicaid	$4,848.62
Rate for Payer: Hawaii Medical Service Association ABD	$4,848.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,848.62
Rate for Payer: Kaiser Permanente Medicaid	$4,848.62
Rate for Payer: Ohana Health Plan Medicaid	$4,848.62
Rate for Payer: UnitedHealthcare Medicaid	$4,848.62

MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS

Facility

$3,203.76

Service Code	APR-DRG 4212
Min. Negotiated Rate	$3,203.76
Max. Negotiated Rate	$3,203.76
Rate for Payer: AlohaCare Medicaid	$3,203.76
Rate for Payer: Hawaii Medical Service Association ABD	$3,203.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,203.76
Rate for Payer: Kaiser Permanente Medicaid	$3,203.76
Rate for Payer: Ohana Health Plan Medicaid	$3,203.76
Rate for Payer: UnitedHealthcare Medicaid	$3,203.76

MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS

Facility

$9,535.49

Service Code	APR-DRG 4214
Min. Negotiated Rate	$9,535.49
Max. Negotiated Rate	$9,535.49
Rate for Payer: AlohaCare Medicaid	$9,535.49
Rate for Payer: Hawaii Medical Service Association ABD	$9,535.49
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,535.49
Rate for Payer: Kaiser Permanente Medicaid	$9,535.49
Rate for Payer: Ohana Health Plan Medicaid	$9,535.49
Rate for Payer: UnitedHealthcare Medicaid	$9,535.49

Malyugin Ring 2.0-7.0mm MAL-1002 [3644961]

Facility

$1,089.83

Hospital Charge Code	3644961
Hospital Revenue Code	272
Min. Negotiated Rate	$926.36
Max. Negotiated Rate	$1,057.14
Rate for Payer: Cash Price	$708.39
Rate for Payer: Health Management Network Commercial	$926.36
Rate for Payer: MDX Hawaii PPO	$1,057.14

Malyugin Ring 2.0-7.0mm MAL-1002 [3644961]

Facility

$1,089.83

Hospital Charge Code	3644961
Hospital Revenue Code	272
Min. Negotiated Rate	$555.81
Max. Negotiated Rate	$1,057.14
Rate for Payer: Cash Price	$708.39
Rate for Payer: Hawaii Western Management Group Commercial	$1,035.34
Rate for Payer: Health Management Network Commercial	$926.36
Rate for Payer: Kaiser Permanente Commercial	$686.59
Rate for Payer: Kaiser Permanente Medicaid	$555.81
Rate for Payer: MDX Hawaii PPO	$1,057.14
Rate for Payer: University Health Alliance Commercial	$794.38

MANNITOL 20 % IV SOLP

Facility

$109.08

Service Code	NDC 00990771502
Hospital Revenue Code	250
Min. Negotiated Rate	$55.63
Max. Negotiated Rate	$105.81
Rate for Payer: Cash Price	$70.90
Rate for Payer: Hawaii Western Management Group Commercial	$103.63
Rate for Payer: Health Management Network Commercial	$92.72
Rate for Payer: Kaiser Permanente Commercial	$68.72
Rate for Payer: Kaiser Permanente Medicaid	$55.63
Rate for Payer: MDX Hawaii PPO	$105.81
Rate for Payer: UnitedHealthcare Medicaid	$65.45
Rate for Payer: University Health Alliance Commercial	$79.51

MANNITOL 20 % IV SOLP

Facility

$287.96

Service Code	NDC 00338035702
Hospital Revenue Code	250
Min. Negotiated Rate	$244.77
Max. Negotiated Rate	$279.32
Rate for Payer: Cash Price	$187.17
Rate for Payer: Health Management Network Commercial	$244.77
Rate for Payer: MDX Hawaii PPO	$279.32

MANNITOL 20 % IV SOLP

Facility

$109.08

Service Code	NDC 00990771512
Hospital Revenue Code	250
Min. Negotiated Rate	$92.72
Max. Negotiated Rate	$105.81
Rate for Payer: Cash Price	$70.90
Rate for Payer: Health Management Network Commercial	$92.72
Rate for Payer: MDX Hawaii PPO	$105.81

MANNITOL 20 % IV SOLP

Facility

$287.96

Service Code	NDC 00338035702
Hospital Revenue Code	250
Min. Negotiated Rate	$146.86
Max. Negotiated Rate	$279.32
Rate for Payer: Cash Price	$187.17
Rate for Payer: Hawaii Western Management Group Commercial	$273.56
Rate for Payer: Health Management Network Commercial	$244.77
Rate for Payer: Kaiser Permanente Commercial	$181.41
Rate for Payer: Kaiser Permanente Medicaid	$146.86
Rate for Payer: MDX Hawaii PPO	$279.32
Rate for Payer: UnitedHealthcare Medicaid	$172.78
Rate for Payer: University Health Alliance Commercial	$209.89

MANNITOL 20 % IV SOLP

Facility

$109.08

Service Code	NDC 00990771502
Hospital Revenue Code	250
Min. Negotiated Rate	$92.72
Max. Negotiated Rate	$105.81
Rate for Payer: Cash Price	$70.90
Rate for Payer: Health Management Network Commercial	$92.72
Rate for Payer: MDX Hawaii PPO	$105.81

MANNITOL 20 % IV SOLP

Facility

$109.08

Service Code	NDC 00990771512
Hospital Revenue Code	250
Min. Negotiated Rate	$55.63
Max. Negotiated Rate	$105.81
Rate for Payer: Cash Price	$70.90
Rate for Payer: Hawaii Western Management Group Commercial	$103.63
Rate for Payer: Health Management Network Commercial	$92.72
Rate for Payer: Kaiser Permanente Commercial	$68.72
Rate for Payer: Kaiser Permanente Medicaid	$55.63
Rate for Payer: MDX Hawaii PPO	$105.81
Rate for Payer: UnitedHealthcare Medicaid	$65.45
Rate for Payer: University Health Alliance Commercial	$79.51

MARSUPIALIZATION OF BARTHOLIN'S GLAND CYST

Facility

$6,183.00

Service Code	CPT 56440
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$3,824.16
Rate for Payer: AlohaCare Medicare	$3,824.16
Rate for Payer: Devoted Health Medicare	$4,206.58
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	$3,824.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,824.16
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,824.16
Rate for Payer: Ohana Health Plan Medicaid	$4,206.58
Rate for Payer: Ohana Health Plan Medicare	$3,824.16
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,824.16
Rate for Payer: University Health Alliance Commercial	$5,160.40

MARSUPIALIZATION OF CYST OR ABSCESS OF LIVER

Facility

$14,715.00

Service Code	CPT 47300
Hospital Revenue Code	360
Min. Negotiated Rate	$563.07
Max. Negotiated Rate	$14,715.00
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$14,715.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,154.45
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$563.07

MASTECTOMY FOR MALIGNANCY WITH CC/MCC

Facility

$33,233.85

Service Code	MSDRG 582
Min. Negotiated Rate	$25,340.12
Max. Negotiated Rate	$33,233.85
Rate for Payer: AlohaCare Medicare	$25,340.12
Rate for Payer: Devoted Health Medicare	$27,874.13
Rate for Payer: Hawaii Medical Service Association Commercial	$25,456.99
Rate for Payer: Hawaii Medical Service Association Medicare	$25,340.12
Rate for Payer: Humana Medicare	$25,340.12
Rate for Payer: Kaiser Permanente Commercial	$33,233.85
Rate for Payer: Kaiser Permanente Medicare	$25,340.12
Rate for Payer: Ohana Health Plan Medicare	$25,340.12
Rate for Payer: UnitedHealthcare Medicare	$25,340.12

MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC

Facility

$29,745.90

Service Code	MSDRG 583
Min. Negotiated Rate	$22,680.63
Max. Negotiated Rate	$29,745.90
Rate for Payer: AlohaCare Medicare	$22,680.63
Rate for Payer: Devoted Health Medicare	$24,948.69
Rate for Payer: Hawaii Medical Service Association Commercial	$23,239.15
Rate for Payer: Hawaii Medical Service Association Medicare	$22,680.63
Rate for Payer: Humana Medicare	$22,680.63
Rate for Payer: Kaiser Permanente Commercial	$29,745.90
Rate for Payer: Kaiser Permanente Medicare	$22,680.63
Rate for Payer: Ohana Health Plan Medicare	$22,680.63
Rate for Payer: UnitedHealthcare Medicare	$22,680.63

MASTECTOMY, MODIFIED RADICAL, INCLUDING AXILLARY LYMPH NODES, WITH OR WITHOUT PECTORALIS MINOR MUSCLE, BUT EXCLUDING PECTORALIS MAJOR MUSCLE

Facility

$24,500.00

Service Code	CPT 19307
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$24,500.00
Rate for Payer: AlohaCare Medicaid	$7,844.33
Rate for Payer: AlohaCare Medicare	$7,844.33
Rate for Payer: Devoted Health Medicare	$8,628.76
Rate for Payer: Hawaii Medical Service Association ABD	$1,900.00
Rate for Payer: Hawaii Medical Service Association Commercial	$17,484.00
Rate for Payer: Hawaii Medical Service Association Medicare	$7,844.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,902.37
Rate for Payer: Humana Medicare	$7,844.33
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$7,844.33
Rate for Payer: Ohana Health Plan Medicaid	$8,628.76
Rate for Payer: Ohana Health Plan Medicare	$7,844.33
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$7,844.33
Rate for Payer: University Health Alliance Commercial	$24,500.00

MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY);

Facility

$9,416.00

Service Code	CPT 19301
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	$6,743.44

MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY); WITH AXILLARY LYMPHADENECTOMY

Facility

$16,700.00

Service Code	CPT 19302
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$16,700.00
Rate for Payer: AlohaCare Medicaid	$7,844.33
Rate for Payer: AlohaCare Medicare	$7,844.33
Rate for Payer: Devoted Health Medicare	$8,628.76
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$14,715.00
Rate for Payer: Hawaii Medical Service Association Medicare	$7,844.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,154.45
Rate for Payer: Humana Medicare	$7,844.33
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$7,844.33
Rate for Payer: Ohana Health Plan Medicaid	$8,628.76
Rate for Payer: Ohana Health Plan Medicare	$7,844.33
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$7,844.33
Rate for Payer: University Health Alliance Commercial	$16,700.00

MASTECTOMY PROCEDURES

Facility

$5,839.48

Service Code	APR-DRG 3621
Min. Negotiated Rate	$5,839.48
Max. Negotiated Rate	$5,839.48
Rate for Payer: AlohaCare Medicaid	$5,839.48
Rate for Payer: Hawaii Medical Service Association ABD	$5,839.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,839.48
Rate for Payer: Kaiser Permanente Medicaid	$5,839.48
Rate for Payer: Ohana Health Plan Medicaid	$5,839.48
Rate for Payer: UnitedHealthcare Medicaid	$5,839.48

MASTECTOMY PROCEDURES

Facility

$17,709.49

Service Code	APR-DRG 3624
Min. Negotiated Rate	$17,709.49
Max. Negotiated Rate	$17,709.49
Rate for Payer: AlohaCare Medicaid	$17,709.49
Rate for Payer: Hawaii Medical Service Association ABD	$17,709.49
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17,709.49
Rate for Payer: Kaiser Permanente Medicaid	$17,709.49
Rate for Payer: Ohana Health Plan Medicaid	$17,709.49
Rate for Payer: UnitedHealthcare Medicaid	$17,709.49

MASTECTOMY PROCEDURES

Facility

$7,783.64

Service Code	APR-DRG 3622
Min. Negotiated Rate	$7,783.64
Max. Negotiated Rate	$7,783.64
Rate for Payer: AlohaCare Medicaid	$7,783.64
Rate for Payer: Hawaii Medical Service Association ABD	$7,783.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,783.64
Rate for Payer: Kaiser Permanente Medicaid	$7,783.64
Rate for Payer: Ohana Health Plan Medicaid	$7,783.64
Rate for Payer: UnitedHealthcare Medicaid	$7,783.64

Know your out-of-pocket cost for care.

All Charges