Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$9,416.00

Service Code	CPT 38531
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, SUPERFICIAL

Facility

$6,183.00

Service Code	CPT 38500
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
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	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,625.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
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

Biosurge Kit w/ 5.0cc Allosync Pure ABS-2016-02 [3644999]

Facility

$11,712.50

Hospital Charge Code	3644999
Hospital Revenue Code	272
Min. Negotiated Rate	$9,955.62
Max. Negotiated Rate	$11,361.12
Rate for Payer: Cash Price	$7,613.12
Rate for Payer: Health Management Network Commercial	$9,955.62
Rate for Payer: MDX Hawaii PPO	$11,361.12

Biosurge Kit w/ 5.0cc Allosync Pure ABS-2016-02 [3644999]

Facility

$11,712.50

Hospital Charge Code	3644999
Hospital Revenue Code	272
Min. Negotiated Rate	$5,973.38
Max. Negotiated Rate	$11,361.12
Rate for Payer: Cash Price	$7,613.12
Rate for Payer: Hawaii Western Management Group Commercial	$11,126.88
Rate for Payer: Health Management Network Commercial	$9,955.62
Rate for Payer: Kaiser Permanente Commercial	$7,378.88
Rate for Payer: Kaiser Permanente Medicaid	$5,973.38
Rate for Payer: MDX Hawaii PPO	$11,361.12
Rate for Payer: University Health Alliance Commercial	$8,537.24

BIPOLAR DISORDERS

Facility

$5,059.62

Service Code	APR-DRG 7533
Min. Negotiated Rate	$5,059.62
Max. Negotiated Rate	$5,059.62
Rate for Payer: AlohaCare Medicaid	$5,059.62
Rate for Payer: Hawaii Medical Service Association ABD	$5,059.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,059.62
Rate for Payer: Kaiser Permanente Medicaid	$5,059.62
Rate for Payer: Ohana Health Plan Medicaid	$5,059.62
Rate for Payer: UnitedHealthcare Medicaid	$5,059.62

BIPOLAR DISORDERS

Facility

$13,084.42

Service Code	APR-DRG 7534
Min. Negotiated Rate	$13,084.42
Max. Negotiated Rate	$13,084.42
Rate for Payer: AlohaCare Medicaid	$13,084.42
Rate for Payer: Hawaii Medical Service Association ABD	$13,084.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,084.42
Rate for Payer: Kaiser Permanente Medicaid	$13,084.42
Rate for Payer: Ohana Health Plan Medicaid	$13,084.42
Rate for Payer: UnitedHealthcare Medicaid	$13,084.42

BIPOLAR DISORDERS

Facility

$2,778.44

Service Code	APR-DRG 7531
Min. Negotiated Rate	$2,778.44
Max. Negotiated Rate	$2,778.44
Rate for Payer: AlohaCare Medicaid	$2,778.44
Rate for Payer: Hawaii Medical Service Association ABD	$2,778.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,778.44
Rate for Payer: Kaiser Permanente Medicaid	$2,778.44
Rate for Payer: Ohana Health Plan Medicaid	$2,778.44
Rate for Payer: UnitedHealthcare Medicaid	$2,778.44

BIPOLAR DISORDERS

Facility

$3,376.01

Service Code	APR-DRG 7532
Min. Negotiated Rate	$3,376.01
Max. Negotiated Rate	$3,376.01
Rate for Payer: AlohaCare Medicaid	$3,376.01
Rate for Payer: Hawaii Medical Service Association ABD	$3,376.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,376.01
Rate for Payer: Kaiser Permanente Medicaid	$3,376.01
Rate for Payer: Ohana Health Plan Medicaid	$3,376.01
Rate for Payer: UnitedHealthcare Medicaid	$3,376.01

BISACODYL 10 MG PR SUPP

Facility

$2.16

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$2.10
Rate for Payer: Cash Price	$1.40
Rate for Payer: Cash Price	$1.13
Rate for Payer: Health Management Network Commercial	$1.48
Rate for Payer: Health Management Network Commercial	$1.84
Rate for Payer: MDX Hawaii PPO	$1.69
Rate for Payer: MDX Hawaii PPO	$2.10

BISACODYL 10 MG PR SUPP

Facility

$1.74

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$1.69
Rate for Payer: Cash Price	$1.13
Rate for Payer: Cash Price	$1.40
Rate for Payer: Hawaii Western Management Group Commercial	$1.65
Rate for Payer: Hawaii Western Management Group Commercial	$2.05
Rate for Payer: Health Management Network Commercial	$1.48
Rate for Payer: Health Management Network Commercial	$1.84
Rate for Payer: Kaiser Permanente Commercial	$1.10
Rate for Payer: Kaiser Permanente Commercial	$1.36
Rate for Payer: Kaiser Permanente Medicaid	$0.89
Rate for Payer: Kaiser Permanente Medicaid	$1.10
Rate for Payer: MDX Hawaii PPO	$1.69
Rate for Payer: MDX Hawaii PPO	$2.10
Rate for Payer: UnitedHealthcare Medicaid	$1.30
Rate for Payer: UnitedHealthcare Medicaid	$1.04
Rate for Payer: University Health Alliance Commercial	$1.27
Rate for Payer: University Health Alliance Commercial	$1.57

BISACODYL 5 MG PO TAB DR EC

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: MDX Hawaii PPO	$1.16

BISACODYL 5 MG PO TAB DR EC

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87

BISMUTH SUBSALICYLATE 525 MG/15 ML PO SUSP

Facility

$20.85

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$20.22
Rate for Payer: Cash Price	$13.55
Rate for Payer: Hawaii Western Management Group Commercial	$19.81
Rate for Payer: Health Management Network Commercial	$17.72
Rate for Payer: Kaiser Permanente Commercial	$13.14
Rate for Payer: Kaiser Permanente Medicaid	$10.63
Rate for Payer: MDX Hawaii PPO	$20.22
Rate for Payer: UnitedHealthcare Medicaid	$12.51
Rate for Payer: University Health Alliance Commercial	$15.20

BISMUTH SUBSALICYLATE 525 MG/15 ML PO SUSP

Facility

$20.85

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$17.72
Max. Negotiated Rate	$20.22
Rate for Payer: Cash Price	$13.55
Rate for Payer: Health Management Network Commercial	$17.72
Rate for Payer: MDX Hawaii PPO	$20.22

BLADDER INSTILLATION OF ANTICARCINOGENIC AGENT (INCLUDING RETENTION TIME)

Facility

$2,837.00

Service Code	CPT 51720
Hospital Revenue Code	360
Min. Negotiated Rate	$68.68
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$823.75
Rate for Payer: AlohaCare Medicare	$823.75
Rate for Payer: Devoted Health Medicare	$906.12
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	$823.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Humana Medicare	$823.75
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$823.75
Rate for Payer: Ohana Health Plan Medicaid	$906.12
Rate for Payer: Ohana Health Plan Medicare	$823.75
Rate for Payer: UnitedHealthcare Medicaid	$68.68
Rate for Payer: UnitedHealthcare Medicare	$823.75

BLADDER IRRIGATION, SIMPLE, LAVAGE AND/OR INSTILLATION

Facility

$2,837.00

Service Code	CPT 51700
Hospital Revenue Code	360
Min. Negotiated Rate	$30.96
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$295.16
Rate for Payer: AlohaCare Medicare	$295.16
Rate for Payer: Devoted Health Medicare	$324.68
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	$295.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Humana Medicare	$295.16
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$295.16
Rate for Payer: Ohana Health Plan Medicaid	$324.68
Rate for Payer: Ohana Health Plan Medicare	$295.16
Rate for Payer: UnitedHealthcare Medicaid	$30.96
Rate for Payer: UnitedHealthcare Medicare	$295.16

Blade 1.0mm Clearcut Sideport 8065921540 [3640134]

Facility

$123.08

Hospital Charge Code	3640134
Hospital Revenue Code	272
Min. Negotiated Rate	$104.62
Max. Negotiated Rate	$119.39
Rate for Payer: Cash Price	$80.00
Rate for Payer: Health Management Network Commercial	$104.62
Rate for Payer: MDX Hawaii PPO	$119.39

Blade 1.0mm Clearcut Sideport 8065921540 [3640134]

Facility

$123.08

Hospital Charge Code	3640134
Hospital Revenue Code	272
Min. Negotiated Rate	$62.77
Max. Negotiated Rate	$119.39
Rate for Payer: Cash Price	$80.00
Rate for Payer: Hawaii Western Management Group Commercial	$116.93
Rate for Payer: Health Management Network Commercial	$104.62
Rate for Payer: Kaiser Permanente Commercial	$77.54
Rate for Payer: Kaiser Permanente Medicaid	$62.77
Rate for Payer: MDX Hawaii PPO	$119.39
Rate for Payer: University Health Alliance Commercial	$89.71

Blade Arthro Serfas 90-S Cruise 0279-401-200 [3640626]

Facility

$1,065.25

Hospital Charge Code	3640626
Hospital Revenue Code	272
Min. Negotiated Rate	$905.46
Max. Negotiated Rate	$1,033.29
Rate for Payer: Cash Price	$692.41
Rate for Payer: Health Management Network Commercial	$905.46
Rate for Payer: MDX Hawaii PPO	$1,033.29

Blade Arthro Serfas 90-S Cruise 0279-401-200 [3640626]

Facility

$1,065.25

Hospital Charge Code	3640626
Hospital Revenue Code	272
Min. Negotiated Rate	$543.28
Max. Negotiated Rate	$1,033.29
Rate for Payer: Cash Price	$692.41
Rate for Payer: Hawaii Western Management Group Commercial	$1,011.99
Rate for Payer: Health Management Network Commercial	$905.46
Rate for Payer: Kaiser Permanente Commercial	$671.11
Rate for Payer: Kaiser Permanente Medicaid	$543.28
Rate for Payer: MDX Hawaii PPO	$1,033.29
Rate for Payer: University Health Alliance Commercial	$776.46

Blade Brasseler EZX Sz 50 BRXTB500 [3642901]

Facility

$6,753.00

Hospital Charge Code	3642901
Hospital Revenue Code	272
Min. Negotiated Rate	$3,444.03
Max. Negotiated Rate	$6,550.41
Rate for Payer: Cash Price	$4,389.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,415.35
Rate for Payer: Health Management Network Commercial	$5,740.05
Rate for Payer: Kaiser Permanente Commercial	$4,254.39
Rate for Payer: Kaiser Permanente Medicaid	$3,444.03
Rate for Payer: MDX Hawaii PPO	$6,550.41
Rate for Payer: University Health Alliance Commercial	$4,922.26

Blade Brasseler EZX Sz 50 BRXTB500 [3642901]

Facility

$6,753.00

Hospital Charge Code	3642901
Hospital Revenue Code	272
Min. Negotiated Rate	$5,740.05
Max. Negotiated Rate	$6,550.41
Rate for Payer: Cash Price	$4,389.45
Rate for Payer: Health Management Network Commercial	$5,740.05
Rate for Payer: MDX Hawaii PPO	$6,550.41

Blade Brasseler EZX Sz 51 BRXTB510 [3642899]

Facility

$6,753.00

Hospital Charge Code	3642899
Hospital Revenue Code	272
Min. Negotiated Rate	$5,740.05
Max. Negotiated Rate	$6,550.41
Rate for Payer: Cash Price	$4,389.45
Rate for Payer: Health Management Network Commercial	$5,740.05
Rate for Payer: MDX Hawaii PPO	$6,550.41

Blade Brasseler EZX Sz 51 BRXTB510 [3642899]

Facility

$6,753.00

Hospital Charge Code	3642899
Hospital Revenue Code	272
Min. Negotiated Rate	$3,444.03
Max. Negotiated Rate	$6,550.41
Rate for Payer: Cash Price	$4,389.45
Rate for Payer: Hawaii Western Management Group Commercial	$6,415.35
Rate for Payer: Health Management Network Commercial	$5,740.05
Rate for Payer: Kaiser Permanente Commercial	$4,254.39
Rate for Payer: Kaiser Permanente Medicaid	$3,444.03
Rate for Payer: MDX Hawaii PPO	$6,550.41
Rate for Payer: University Health Alliance Commercial	$4,922.26

Blade Brasseler EZX Sz 52 BRXTB520 [3642900]

Facility

$6,753.00

Hospital Charge Code	3642900
Hospital Revenue Code	272
Min. Negotiated Rate	$5,740.05
Max. Negotiated Rate	$6,550.41
Rate for Payer: Cash Price	$4,389.45
Rate for Payer: Health Management Network Commercial	$5,740.05
Rate for Payer: MDX Hawaii PPO	$6,550.41

Know your out-of-pocket cost for care.

All Charges