Kona Community Hospital

All Charges

Charge

Type

Setting

Price

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC

Facility

$39,246.20

Service Code	MSDRG 941
Min. Negotiated Rate	$26,669.87
Max. Negotiated Rate	$39,246.20
Rate for Payer: AlohaCare Medicare	$26,669.87
Rate for Payer: Devoted Health Medicare	$29,336.86
Rate for Payer: Hawaii Medical Service Association Commercial	$39,246.20
Rate for Payer: Hawaii Medical Service Association Medicare	$26,669.87
Rate for Payer: Humana Medicare	$26,669.87
Rate for Payer: Kaiser Permanente Commercial	$34,977.82
Rate for Payer: Kaiser Permanente Medicare	$26,669.87
Rate for Payer: Ohana Health Plan Medicare	$26,669.87
Rate for Payer: UnitedHealthcare Medicare	$26,669.87

O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS

Facility

$87,460.20

Service Code	MSDRG 876
Min. Negotiated Rate	$50,834.12
Max. Negotiated Rate	$87,460.20
Rate for Payer: AlohaCare Medicare	$50,834.12
Rate for Payer: Devoted Health Medicare	$55,917.53
Rate for Payer: Hawaii Medical Service Association Commercial	$87,460.20
Rate for Payer: Hawaii Medical Service Association Medicare	$50,834.12
Rate for Payer: Humana Medicare	$50,834.12
Rate for Payer: Kaiser Permanente Commercial	$66,669.52
Rate for Payer: Kaiser Permanente Medicare	$50,834.12
Rate for Payer: Ohana Health Plan Medicare	$50,834.12
Rate for Payer: UnitedHealthcare Medicare	$50,834.12

Orthalign Plus Navigation Unit Disp 403001 [3644137]

Facility

$7,787.25

Hospital Charge Code	3644137
Hospital Revenue Code	272
Min. Negotiated Rate	$6,619.16
Max. Negotiated Rate	$7,553.63
Rate for Payer: Cash Price	$5,061.71
Rate for Payer: Health Management Network Commercial	$6,619.16
Rate for Payer: MDX Hawaii PPO	$7,553.63

Orthalign Plus Navigation Unit Disp 403001 [3644137]

Facility

$7,787.25

Hospital Charge Code	3644137
Hospital Revenue Code	272
Min. Negotiated Rate	$3,971.50
Max. Negotiated Rate	$7,553.63
Rate for Payer: Cash Price	$5,061.71
Rate for Payer: Hawaii Western Management Group Commercial	$7,397.89
Rate for Payer: Health Management Network Commercial	$6,619.16
Rate for Payer: Kaiser Permanente Commercial	$4,905.97
Rate for Payer: Kaiser Permanente Medicaid	$3,971.50
Rate for Payer: MDX Hawaii PPO	$7,553.63
Rate for Payer: University Health Alliance Commercial	$5,676.13

OSELTAMIVIR 30 MG PO CAP

Facility

$76.71

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$65.20
Max. Negotiated Rate	$74.41
Rate for Payer: Cash Price	$49.86
Rate for Payer: Health Management Network Commercial	$65.20
Rate for Payer: MDX Hawaii PPO	$74.41

OSELTAMIVIR 30 MG PO CAP

Facility

$76.71

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$39.12
Max. Negotiated Rate	$74.41
Rate for Payer: Cash Price	$49.86
Rate for Payer: Hawaii Western Management Group Commercial	$72.87
Rate for Payer: Health Management Network Commercial	$65.20
Rate for Payer: Kaiser Permanente Commercial	$48.33
Rate for Payer: Kaiser Permanente Medicaid	$39.12
Rate for Payer: MDX Hawaii PPO	$74.41
Rate for Payer: UnitedHealthcare Medicaid	$46.03
Rate for Payer: University Health Alliance Commercial	$55.91

OSELTAMIVIR 6 MG/ML PO SUSR (PER BOTTLE) WHR

Facility

$579.93

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$492.94
Max. Negotiated Rate	$562.53
Rate for Payer: Cash Price	$376.95
Rate for Payer: Cash Price	$377.36
Rate for Payer: Health Management Network Commercial	$493.47
Rate for Payer: Health Management Network Commercial	$492.94
Rate for Payer: MDX Hawaii PPO	$563.13
Rate for Payer: MDX Hawaii PPO	$562.53

OSELTAMIVIR 6 MG/ML PO SUSR (PER BOTTLE) WHR

Facility

$579.93

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$295.76
Max. Negotiated Rate	$562.53
Rate for Payer: Cash Price	$376.95
Rate for Payer: Cash Price	$377.36
Rate for Payer: Hawaii Western Management Group Commercial	$550.93
Rate for Payer: Hawaii Western Management Group Commercial	$551.52
Rate for Payer: Health Management Network Commercial	$493.47
Rate for Payer: Health Management Network Commercial	$492.94
Rate for Payer: Kaiser Permanente Commercial	$365.36
Rate for Payer: Kaiser Permanente Commercial	$365.75
Rate for Payer: Kaiser Permanente Medicaid	$296.08
Rate for Payer: Kaiser Permanente Medicaid	$295.76
Rate for Payer: MDX Hawaii PPO	$563.13
Rate for Payer: MDX Hawaii PPO	$562.53
Rate for Payer: UnitedHealthcare Medicaid	$347.96
Rate for Payer: UnitedHealthcare Medicaid	$348.33
Rate for Payer: University Health Alliance Commercial	$423.16
Rate for Payer: University Health Alliance Commercial	$422.71

OSELTAMIVIR 75 MG PO CAP

Facility

$82.00

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$53.30
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: MDX Hawaii PPO	$79.54

OSELTAMIVIR 75 MG PO CAP

Facility

$82.00

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$41.82
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$53.30
Rate for Payer: Hawaii Western Management Group Commercial	$77.90
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Kaiser Permanente Commercial	$51.66
Rate for Payer: Kaiser Permanente Medicaid	$41.82
Rate for Payer: MDX Hawaii PPO	$79.54
Rate for Payer: UnitedHealthcare Medicaid	$49.20
Rate for Payer: University Health Alliance Commercial	$59.77

Oss Rs Axle 161035 [3643583]

Facility

$1,932.00

Service Code	HCPCS C1776
Hospital Charge Code	3643583
Hospital Revenue Code	278
Min. Negotiated Rate	$1,081.92
Max. Negotiated Rate	$1,874.04
Rate for Payer: Cash Price	$1,255.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,352.40
Rate for Payer: Health Management Network Commercial	$1,642.20
Rate for Payer: MDX Hawaii PPO	$1,874.04
Rate for Payer: University Health Alliance Commercial	$1,081.92

Oss Rs Axle 161035 [3643583]

Facility

$1,932.00

Service Code	HCPCS C1776
Hospital Charge Code	3643583
Hospital Revenue Code	278
Min. Negotiated Rate	$985.32
Max. Negotiated Rate	$1,874.04
Rate for Payer: Cash Price	$1,255.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,352.40
Rate for Payer: Health Management Network Commercial	$1,642.20
Rate for Payer: Kaiser Permanente Commercial	$1,217.16
Rate for Payer: Kaiser Permanente Medicaid	$985.32
Rate for Payer: MDX Hawaii PPO	$1,874.04
Rate for Payer: University Health Alliance Commercial	$1,081.92

Oss Rs Poly Fem Bushing Set/2 161034 [3643584]

Facility

$1,785.00

Service Code	HCPCS C1776
Hospital Charge Code	3643584
Hospital Revenue Code	278
Min. Negotiated Rate	$910.35
Max. Negotiated Rate	$1,731.45
Rate for Payer: Cash Price	$1,160.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,249.50
Rate for Payer: Health Management Network Commercial	$1,517.25
Rate for Payer: Kaiser Permanente Commercial	$1,124.55
Rate for Payer: Kaiser Permanente Medicaid	$910.35
Rate for Payer: MDX Hawaii PPO	$1,731.45
Rate for Payer: University Health Alliance Commercial	$999.60

Oss Rs Poly Fem Bushing Set/2 161034 [3643584]

Facility

$1,785.00

Service Code	HCPCS C1776
Hospital Charge Code	3643584
Hospital Revenue Code	278
Min. Negotiated Rate	$999.60
Max. Negotiated Rate	$1,731.45
Rate for Payer: Cash Price	$1,160.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,249.50
Rate for Payer: Health Management Network Commercial	$1,517.25
Rate for Payer: MDX Hawaii PPO	$1,731.45
Rate for Payer: University Health Alliance Commercial	$999.60

Oss Tibial Poly Bearing 12mm 150410 [3643582]

Facility

$3,405.00

Service Code	HCPCS C1776
Hospital Charge Code	3643582
Hospital Revenue Code	278
Min. Negotiated Rate	$1,736.55
Max. Negotiated Rate	$3,302.85
Rate for Payer: Cash Price	$2,213.25
Rate for Payer: Hawaii Western Management Group Commercial	$2,383.50
Rate for Payer: Health Management Network Commercial	$2,894.25
Rate for Payer: Kaiser Permanente Commercial	$2,145.15
Rate for Payer: Kaiser Permanente Medicaid	$1,736.55
Rate for Payer: MDX Hawaii PPO	$3,302.85
Rate for Payer: University Health Alliance Commercial	$1,906.80

Oss Tibial Poly Bearing 12mm 150410 [3643582]

Facility

$3,405.00

Service Code	HCPCS C1776
Hospital Charge Code	3643582
Hospital Revenue Code	278
Min. Negotiated Rate	$1,906.80
Max. Negotiated Rate	$3,302.85
Rate for Payer: Cash Price	$2,213.25
Rate for Payer: Hawaii Western Management Group Commercial	$2,383.50
Rate for Payer: Health Management Network Commercial	$2,894.25
Rate for Payer: MDX Hawaii PPO	$3,302.85
Rate for Payer: University Health Alliance Commercial	$1,906.80

Osteocon Flap Repair Single Shot Instr AR-4009S [3644637]

Facility

$1,279.67

Hospital Charge Code	3644637
Hospital Revenue Code	272
Min. Negotiated Rate	$1,087.72
Max. Negotiated Rate	$1,241.28
Rate for Payer: Cash Price	$831.79
Rate for Payer: Health Management Network Commercial	$1,087.72
Rate for Payer: MDX Hawaii PPO	$1,241.28

Osteocon Flap Repair Single Shot Instr AR-4009S [3644637]

Facility

$1,279.67

Hospital Charge Code	3644637
Hospital Revenue Code	272
Min. Negotiated Rate	$652.63
Max. Negotiated Rate	$1,241.28
Rate for Payer: Cash Price	$831.79
Rate for Payer: Hawaii Western Management Group Commercial	$1,215.69
Rate for Payer: Health Management Network Commercial	$1,087.72
Rate for Payer: Kaiser Permanente Commercial	$806.19
Rate for Payer: Kaiser Permanente Medicaid	$652.63
Rate for Payer: MDX Hawaii PPO	$1,241.28
Rate for Payer: University Health Alliance Commercial	$932.75

OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS

Facility

$3,383.33

Service Code	APR-DRG 3441
Min. Negotiated Rate	$3,383.33
Max. Negotiated Rate	$3,383.33
Rate for Payer: AlohaCare Medicaid	$3,383.33
Rate for Payer: Hawaii Medical Service Association ABD	$3,383.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,383.33
Rate for Payer: Kaiser Permanente Medicaid	$3,383.33
Rate for Payer: Ohana Health Plan Medicaid	$3,383.33
Rate for Payer: UnitedHealthcare Medicaid	$3,383.33

OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS

Facility

$10,292.01

Service Code	APR-DRG 3444
Min. Negotiated Rate	$10,292.01
Max. Negotiated Rate	$10,292.01
Rate for Payer: AlohaCare Medicaid	$10,292.01
Rate for Payer: Hawaii Medical Service Association ABD	$10,292.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,292.01
Rate for Payer: Kaiser Permanente Medicaid	$10,292.01
Rate for Payer: Ohana Health Plan Medicaid	$10,292.01
Rate for Payer: UnitedHealthcare Medicaid	$10,292.01

OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS

Facility

$4,269.13

Service Code	APR-DRG 3442
Min. Negotiated Rate	$4,269.13
Max. Negotiated Rate	$4,269.13
Rate for Payer: AlohaCare Medicaid	$4,269.13
Rate for Payer: Hawaii Medical Service Association ABD	$4,269.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,269.13
Rate for Payer: Kaiser Permanente Medicaid	$4,269.13
Rate for Payer: Ohana Health Plan Medicaid	$4,269.13
Rate for Payer: UnitedHealthcare Medicaid	$4,269.13

OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS

Facility

$5,937.55

Service Code	APR-DRG 3443
Min. Negotiated Rate	$5,937.55
Max. Negotiated Rate	$5,937.55
Rate for Payer: AlohaCare Medicaid	$5,937.55
Rate for Payer: Hawaii Medical Service Association ABD	$5,937.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,937.55
Rate for Payer: Kaiser Permanente Medicaid	$5,937.55
Rate for Payer: Ohana Health Plan Medicaid	$5,937.55
Rate for Payer: UnitedHealthcare Medicaid	$5,937.55

OSTEOMYELITIS WITH CC

Facility

$39,680.12

Service Code	MSDRG 540
Min. Negotiated Rate	$17,049.93
Max. Negotiated Rate	$39,680.12
Rate for Payer: AlohaCare Medicare	$17,049.93
Rate for Payer: Devoted Health Medicare	$18,754.92
Rate for Payer: Hawaii Medical Service Association Commercial	$39,680.12
Rate for Payer: Hawaii Medical Service Association Medicare	$17,049.93
Rate for Payer: Humana Medicare	$17,049.93
Rate for Payer: Kaiser Permanente Commercial	$22,361.17
Rate for Payer: Kaiser Permanente Medicare	$17,049.93
Rate for Payer: Ohana Health Plan Medicare	$17,049.93
Rate for Payer: UnitedHealthcare Medicare	$17,049.93

OSTEOMYELITIS WITH MCC

Facility

$39,680.12

Service Code	MSDRG 539
Min. Negotiated Rate	$25,907.01
Max. Negotiated Rate	$39,680.12
Rate for Payer: AlohaCare Medicare	$25,907.01
Rate for Payer: Devoted Health Medicare	$28,497.71
Rate for Payer: Hawaii Medical Service Association Commercial	$39,680.12
Rate for Payer: Hawaii Medical Service Association Medicare	$25,907.01
Rate for Payer: Humana Medicare	$25,907.01
Rate for Payer: Kaiser Permanente Commercial	$33,977.32
Rate for Payer: Kaiser Permanente Medicare	$25,907.01
Rate for Payer: Ohana Health Plan Medicare	$25,907.01
Rate for Payer: UnitedHealthcare Medicare	$25,907.01

OSTEOMYELITIS WITHOUT CC/MCC

Facility

$39,680.12

Service Code	MSDRG 541
Min. Negotiated Rate	$10,356.49
Max. Negotiated Rate	$39,680.12
Rate for Payer: AlohaCare Medicare	$10,356.49
Rate for Payer: Devoted Health Medicare	$11,392.14
Rate for Payer: Hawaii Medical Service Association Commercial	$39,680.12
Rate for Payer: Hawaii Medical Service Association Medicare	$10,356.49
Rate for Payer: Humana Medicare	$10,356.49
Rate for Payer: Kaiser Permanente Commercial	$13,308.38
Rate for Payer: Kaiser Permanente Medicare	$10,356.49
Rate for Payer: Ohana Health Plan Medicare	$10,356.49
Rate for Payer: UnitedHealthcare Medicare	$10,356.49

Know your out-of-pocket cost for care.

All Charges