Kona Community Hospital

All Charges

Charge

Type

Setting

Price

OTHER SMALL & LARGE BOWEL PROCEDURES

Facility

$5,559.29

Service Code	APR-DRG 2231
Min. Negotiated Rate	$5,559.29
Max. Negotiated Rate	$5,559.29
Rate for Payer: AlohaCare Medicaid	$5,559.29
Rate for Payer: Hawaii Medical Service Association ABD	$5,559.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,559.29
Rate for Payer: Kaiser Permanente Medicaid	$5,559.29
Rate for Payer: Ohana Health Plan Medicaid	$5,559.29
Rate for Payer: UnitedHealthcare Medicaid	$5,559.29

OTHER SMALL & LARGE BOWEL PROCEDURES

Facility

$20,054.20

Service Code	APR-DRG 2234
Min. Negotiated Rate	$20,054.20
Max. Negotiated Rate	$20,054.20
Rate for Payer: AlohaCare Medicaid	$20,054.20
Rate for Payer: Hawaii Medical Service Association ABD	$20,054.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20,054.20
Rate for Payer: Kaiser Permanente Medicaid	$20,054.20
Rate for Payer: Ohana Health Plan Medicaid	$20,054.20
Rate for Payer: UnitedHealthcare Medicaid	$20,054.20

OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES

Facility

$5,891.70

Service Code	APR-DRG 2222
Min. Negotiated Rate	$5,891.70
Max. Negotiated Rate	$5,891.70
Rate for Payer: AlohaCare Medicaid	$5,891.70
Rate for Payer: Hawaii Medical Service Association ABD	$5,891.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,891.70
Rate for Payer: Kaiser Permanente Medicaid	$5,891.70
Rate for Payer: Ohana Health Plan Medicaid	$5,891.70
Rate for Payer: UnitedHealthcare Medicaid	$5,891.70

OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES

Facility

$9,154.04

Service Code	APR-DRG 2223
Min. Negotiated Rate	$9,154.04
Max. Negotiated Rate	$9,154.04
Rate for Payer: AlohaCare Medicaid	$9,154.04
Rate for Payer: Hawaii Medical Service Association ABD	$9,154.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,154.04
Rate for Payer: Kaiser Permanente Medicaid	$9,154.04
Rate for Payer: Ohana Health Plan Medicaid	$9,154.04
Rate for Payer: UnitedHealthcare Medicaid	$9,154.04

OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES

Facility

$3,774.33

Service Code	APR-DRG 2221
Min. Negotiated Rate	$3,774.33
Max. Negotiated Rate	$3,774.33
Rate for Payer: AlohaCare Medicaid	$3,774.33
Rate for Payer: Hawaii Medical Service Association ABD	$3,774.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,774.33
Rate for Payer: Kaiser Permanente Medicaid	$3,774.33
Rate for Payer: Ohana Health Plan Medicaid	$3,774.33
Rate for Payer: UnitedHealthcare Medicaid	$3,774.33

OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES

Facility

$17,904.35

Service Code	APR-DRG 2224
Min. Negotiated Rate	$17,904.35
Max. Negotiated Rate	$17,904.35
Rate for Payer: AlohaCare Medicaid	$17,904.35
Rate for Payer: Hawaii Medical Service Association ABD	$17,904.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17,904.35
Rate for Payer: Kaiser Permanente Medicaid	$17,904.35
Rate for Payer: Ohana Health Plan Medicaid	$17,904.35
Rate for Payer: UnitedHealthcare Medicaid	$17,904.35

OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$3,717.02

Service Code	APR-DRG 2532
Min. Negotiated Rate	$3,717.02
Max. Negotiated Rate	$3,717.02
Rate for Payer: AlohaCare Medicaid	$3,717.02
Rate for Payer: Hawaii Medical Service Association ABD	$3,717.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,717.02
Rate for Payer: Kaiser Permanente Medicaid	$3,717.02
Rate for Payer: Ohana Health Plan Medicaid	$3,717.02
Rate for Payer: UnitedHealthcare Medicaid	$3,717.02

OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$5,349.15

Service Code	APR-DRG 2533
Min. Negotiated Rate	$5,349.15
Max. Negotiated Rate	$5,349.15
Rate for Payer: AlohaCare Medicaid	$5,349.15
Rate for Payer: Hawaii Medical Service Association ABD	$5,349.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,349.15
Rate for Payer: Kaiser Permanente Medicaid	$5,349.15
Rate for Payer: Ohana Health Plan Medicaid	$5,349.15
Rate for Payer: UnitedHealthcare Medicaid	$5,349.15

OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$8,929.25

Service Code	APR-DRG 2534
Min. Negotiated Rate	$8,929.25
Max. Negotiated Rate	$8,929.25
Rate for Payer: AlohaCare Medicaid	$8,929.25
Rate for Payer: Hawaii Medical Service Association ABD	$8,929.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,929.25
Rate for Payer: Kaiser Permanente Medicaid	$8,929.25
Rate for Payer: Ohana Health Plan Medicaid	$8,929.25
Rate for Payer: UnitedHealthcare Medicaid	$8,929.25

OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$2,924.20

Service Code	APR-DRG 2531
Min. Negotiated Rate	$2,924.20
Max. Negotiated Rate	$2,924.20
Rate for Payer: AlohaCare Medicaid	$2,924.20
Rate for Payer: Hawaii Medical Service Association ABD	$2,924.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,924.20
Rate for Payer: Kaiser Permanente Medicaid	$2,924.20
Rate for Payer: Ohana Health Plan Medicaid	$2,924.20
Rate for Payer: UnitedHealthcare Medicaid	$2,924.20

OTHER VASCULAR PROCEDURES WITH CC

Facility

$68,704.95

Service Code	MSDRG 253
Min. Negotiated Rate	$34,139.33
Max. Negotiated Rate	$68,704.95
Rate for Payer: AlohaCare Medicare	$34,139.33
Rate for Payer: Devoted Health Medicare	$37,553.26
Rate for Payer: Hawaii Medical Service Association Commercial	$68,704.95
Rate for Payer: Hawaii Medical Service Association Medicare	$34,139.33
Rate for Payer: Humana Medicare	$34,139.33
Rate for Payer: Kaiser Permanente Commercial	$44,774.10
Rate for Payer: Kaiser Permanente Medicare	$34,139.33
Rate for Payer: Ohana Health Plan Medicare	$34,139.33
Rate for Payer: UnitedHealthcare Medicare	$34,139.33

OTHER VASCULAR PROCEDURES WITH MCC

Facility

$73,140.64

Service Code	MSDRG 252
Min. Negotiated Rate	$45,880.80
Max. Negotiated Rate	$73,140.64
Rate for Payer: AlohaCare Medicare	$45,880.80
Rate for Payer: Devoted Health Medicare	$50,468.88
Rate for Payer: Hawaii Medical Service Association Commercial	$73,140.64
Rate for Payer: Hawaii Medical Service Association Medicare	$45,880.80
Rate for Payer: Humana Medicare	$45,880.80
Rate for Payer: Kaiser Permanente Commercial	$60,173.18
Rate for Payer: Kaiser Permanente Medicare	$45,880.80
Rate for Payer: Ohana Health Plan Medicare	$45,880.80
Rate for Payer: UnitedHealthcare Medicare	$45,880.80

OTHER VASCULAR PROCEDURES WITHOUT CC/MCC

Facility

$49,660.42

Service Code	MSDRG 254
Min. Negotiated Rate	$23,434.28
Max. Negotiated Rate	$49,660.42
Rate for Payer: AlohaCare Medicare	$23,434.28
Rate for Payer: Devoted Health Medicare	$25,777.71
Rate for Payer: Hawaii Medical Service Association Commercial	$49,660.42
Rate for Payer: Hawaii Medical Service Association Medicare	$23,434.28
Rate for Payer: Humana Medicare	$23,434.28
Rate for Payer: Kaiser Permanente Commercial	$30,734.33
Rate for Payer: Kaiser Permanente Medicare	$23,434.28
Rate for Payer: Ohana Health Plan Medicare	$23,434.28
Rate for Payer: UnitedHealthcare Medicare	$23,434.28

OTITIS MEDIA AND URI WITH MCC

Facility

$20,392.95

Service Code	MSDRG 152
Min. Negotiated Rate	$12,391.00
Max. Negotiated Rate	$20,392.95
Rate for Payer: AlohaCare Medicare	$15,549.22
Rate for Payer: Devoted Health Medicare	$17,104.14
Rate for Payer: Hawaii Medical Service Association Commercial	$12,391.00
Rate for Payer: Hawaii Medical Service Association Medicare	$15,549.22
Rate for Payer: Humana Medicare	$15,549.22
Rate for Payer: Kaiser Permanente Commercial	$20,392.95
Rate for Payer: Kaiser Permanente Medicare	$15,549.22
Rate for Payer: Ohana Health Plan Medicare	$15,549.22
Rate for Payer: UnitedHealthcare Medicare	$15,549.22

OTITIS MEDIA AND URI WITHOUT MCC

Facility

$12,733.95

Service Code	MSDRG 153
Min. Negotiated Rate	$9,709.39
Max. Negotiated Rate	$12,733.95
Rate for Payer: AlohaCare Medicare	$9,709.39
Rate for Payer: Devoted Health Medicare	$10,680.33
Rate for Payer: Hawaii Medical Service Association Commercial	$10,727.61
Rate for Payer: Hawaii Medical Service Association Medicare	$9,709.39
Rate for Payer: Humana Medicare	$9,709.39
Rate for Payer: Kaiser Permanente Commercial	$12,733.95
Rate for Payer: Kaiser Permanente Medicare	$9,709.39
Rate for Payer: Ohana Health Plan Medicare	$9,709.39
Rate for Payer: UnitedHealthcare Medicare	$9,709.39

Over Drill 2.7 x 110mm Solid AO P99-100-2711 [3644544]

Facility

$1,455.04

Hospital Charge Code	3644544
Hospital Revenue Code	272
Min. Negotiated Rate	$1,236.78
Max. Negotiated Rate	$1,411.39
Rate for Payer: Cash Price	$945.78
Rate for Payer: Health Management Network Commercial	$1,236.78
Rate for Payer: MDX Hawaii PPO	$1,411.39

Over Drill 2.7 x 110mm Solid AO P99-100-2711 [3644544]

Facility

$1,455.04

Hospital Charge Code	3644544
Hospital Revenue Code	272
Min. Negotiated Rate	$742.07
Max. Negotiated Rate	$1,411.39
Rate for Payer: Cash Price	$945.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,382.29
Rate for Payer: Health Management Network Commercial	$1,236.78
Rate for Payer: Kaiser Permanente Commercial	$916.68
Rate for Payer: Kaiser Permanente Medicaid	$742.07
Rate for Payer: MDX Hawaii PPO	$1,411.39
Rate for Payer: University Health Alliance Commercial	$1,060.58

Over Drill 4.2 x 120mm Solid AO P99-100-4212 [3644354]

Facility

$1,455.04

Hospital Charge Code	3644354
Hospital Revenue Code	272
Min. Negotiated Rate	$742.07
Max. Negotiated Rate	$1,411.39
Rate for Payer: Cash Price	$945.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,382.29
Rate for Payer: Health Management Network Commercial	$1,236.78
Rate for Payer: Kaiser Permanente Commercial	$916.68
Rate for Payer: Kaiser Permanente Medicaid	$742.07
Rate for Payer: MDX Hawaii PPO	$1,411.39
Rate for Payer: University Health Alliance Commercial	$1,060.58

Over Drill 4.2 x 120mm Solid AO P99-100-4212 [3644354]

Facility

$1,455.04

Hospital Charge Code	3644354
Hospital Revenue Code	272
Min. Negotiated Rate	$1,236.78
Max. Negotiated Rate	$1,411.39
Rate for Payer: Cash Price	$945.78
Rate for Payer: Health Management Network Commercial	$1,236.78
Rate for Payer: MDX Hawaii PPO	$1,411.39

OXALIPLATIN 100 MG/20 ML IV SOLN

Facility

$431.38

Service Code	HCPCS J9263
Hospital Revenue Code	250
Min. Negotiated Rate	$366.67
Max. Negotiated Rate	$418.44
Rate for Payer: Cash Price	$280.40
Rate for Payer: Health Management Network Commercial	$366.67
Rate for Payer: MDX Hawaii PPO	$418.44

OXALIPLATIN 100 MG/20 ML IV SOLN

Facility

$431.38

Service Code	HCPCS J9263
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$418.44
Rate for Payer: Cash Price	$280.40
Rate for Payer: Cash Price	$280.40
Rate for Payer: Hawaii Medical Service Association ABD	$0.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.09
Rate for Payer: Hawaii Western Management Group Commercial	$409.81
Rate for Payer: Health Management Network Commercial	$366.67
Rate for Payer: Kaiser Permanente Commercial	$271.77
Rate for Payer: Kaiser Permanente Medicaid	$220.00
Rate for Payer: MDX Hawaii PPO	$418.44
Rate for Payer: UnitedHealthcare Medicaid	$258.83
Rate for Payer: University Health Alliance Commercial	$314.43

OXALIPLATIN 50 MG/10 ML (5 MG/ML) IV SOLN

Facility

$306.96

Service Code	HCPCS J9263
Hospital Revenue Code	250
Min. Negotiated Rate	$260.92
Max. Negotiated Rate	$297.75
Rate for Payer: Cash Price	$199.52
Rate for Payer: Health Management Network Commercial	$260.92
Rate for Payer: MDX Hawaii PPO	$297.75

OXALIPLATIN 50 MG/10 ML (5 MG/ML) IV SOLN

Facility

$306.96

Service Code	HCPCS J9263
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$297.75
Rate for Payer: Cash Price	$199.52
Rate for Payer: Cash Price	$199.52
Rate for Payer: Hawaii Medical Service Association ABD	$0.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.09
Rate for Payer: Hawaii Western Management Group Commercial	$291.61
Rate for Payer: Health Management Network Commercial	$260.92
Rate for Payer: Kaiser Permanente Commercial	$193.38
Rate for Payer: Kaiser Permanente Medicaid	$156.55
Rate for Payer: MDX Hawaii PPO	$297.75
Rate for Payer: UnitedHealthcare Medicaid	$184.18
Rate for Payer: University Health Alliance Commercial	$223.74

OXCARBAZEPINE 150 MG PO TABLET

Facility

$7.89

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$7.65
Rate for Payer: Cash Price	$5.13
Rate for Payer: Hawaii Western Management Group Commercial	$7.50
Rate for Payer: Health Management Network Commercial	$6.71
Rate for Payer: Kaiser Permanente Commercial	$4.97
Rate for Payer: Kaiser Permanente Medicaid	$4.02
Rate for Payer: MDX Hawaii PPO	$7.65
Rate for Payer: UnitedHealthcare Medicaid	$4.73
Rate for Payer: University Health Alliance Commercial	$5.75

OXCARBAZEPINE 150 MG PO TABLET

Facility

$7.89

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.71
Max. Negotiated Rate	$7.65
Rate for Payer: Cash Price	$5.13
Rate for Payer: Health Management Network Commercial	$6.71
Rate for Payer: MDX Hawaii PPO	$7.65

Know your out-of-pocket cost for care.

All Charges