Kona Community Hospital

All Charges

Charge

Type

Setting

Price

PENIS, TESTES & SCROTAL PROCEDURES

Facility

$8,488.58

Service Code	APR-DRG 4833
Min. Negotiated Rate	$8,488.58
Max. Negotiated Rate	$8,488.58
Rate for Payer: AlohaCare Medicaid	$8,488.58
Rate for Payer: Hawaii Medical Service Association ABD	$8,488.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,488.58
Rate for Payer: Kaiser Permanente Medicaid	$8,488.58
Rate for Payer: Ohana Health Plan Medicaid	$8,488.58
Rate for Payer: UnitedHealthcare Medicaid	$8,488.58

PEPTIC ULCER & GASTRITIS

Facility

$5,892.34

Service Code	APR-DRG 2413
Min. Negotiated Rate	$5,892.34
Max. Negotiated Rate	$5,892.34
Rate for Payer: AlohaCare Medicaid	$5,892.34
Rate for Payer: Hawaii Medical Service Association ABD	$5,892.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,892.34
Rate for Payer: Kaiser Permanente Medicaid	$5,892.34
Rate for Payer: Ohana Health Plan Medicaid	$5,892.34
Rate for Payer: UnitedHealthcare Medicaid	$5,892.34

PEPTIC ULCER & GASTRITIS

Facility

$3,261.07

Service Code	APR-DRG 2411
Min. Negotiated Rate	$3,261.07
Max. Negotiated Rate	$3,261.07
Rate for Payer: AlohaCare Medicaid	$3,261.07
Rate for Payer: Hawaii Medical Service Association ABD	$3,261.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,261.07
Rate for Payer: Kaiser Permanente Medicaid	$3,261.07
Rate for Payer: Ohana Health Plan Medicaid	$3,261.07
Rate for Payer: UnitedHealthcare Medicaid	$3,261.07

PEPTIC ULCER & GASTRITIS

Facility

$11,352.92

Service Code	APR-DRG 2414
Min. Negotiated Rate	$11,352.92
Max. Negotiated Rate	$11,352.92
Rate for Payer: AlohaCare Medicaid	$11,352.92
Rate for Payer: Hawaii Medical Service Association ABD	$11,352.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,352.92
Rate for Payer: Kaiser Permanente Medicaid	$11,352.92
Rate for Payer: Ohana Health Plan Medicaid	$11,352.92
Rate for Payer: UnitedHealthcare Medicaid	$11,352.92

PEPTIC ULCER & GASTRITIS

Facility

$4,027.78

Service Code	APR-DRG 2412
Min. Negotiated Rate	$4,027.78
Max. Negotiated Rate	$4,027.78
Rate for Payer: AlohaCare Medicaid	$4,027.78
Rate for Payer: Hawaii Medical Service Association ABD	$4,027.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,027.78
Rate for Payer: Kaiser Permanente Medicaid	$4,027.78
Rate for Payer: Ohana Health Plan Medicaid	$4,027.78
Rate for Payer: UnitedHealthcare Medicaid	$4,027.78

Perc Insert Kit for 2.9mm PushLock Anchor AR1923PK [3640706]

Facility

$1,804.38

Hospital Charge Code	3640706
Hospital Revenue Code	272
Min. Negotiated Rate	$920.23
Max. Negotiated Rate	$1,750.25
Rate for Payer: Cash Price	$1,172.85
Rate for Payer: Hawaii Western Management Group Commercial	$1,714.16
Rate for Payer: Health Management Network Commercial	$1,533.72
Rate for Payer: Kaiser Permanente Commercial	$1,136.76
Rate for Payer: Kaiser Permanente Medicaid	$920.23
Rate for Payer: MDX Hawaii PPO	$1,750.25
Rate for Payer: University Health Alliance Commercial	$1,315.21

Perc Insert Kit for 2.9mm PushLock Anchor AR1923PK [3640706]

Facility

$1,804.38

Hospital Charge Code	3640706
Hospital Revenue Code	272
Min. Negotiated Rate	$1,533.72
Max. Negotiated Rate	$1,750.25
Rate for Payer: Cash Price	$1,172.85
Rate for Payer: Health Management Network Commercial	$1,533.72
Rate for Payer: MDX Hawaii PPO	$1,750.25

Perc Insert Kit for 3.0mm S-Tak AR1934PI30 [3641356]

Facility

$1,619.88

Hospital Charge Code	3641356
Hospital Revenue Code	272
Min. Negotiated Rate	$1,376.90
Max. Negotiated Rate	$1,571.28
Rate for Payer: Cash Price	$1,052.92
Rate for Payer: Health Management Network Commercial	$1,376.90
Rate for Payer: MDX Hawaii PPO	$1,571.28

Perc Insert Kit for 3.0mm S-Tak AR1934PI30 [3641356]

Facility

$1,619.88

Hospital Charge Code	3641356
Hospital Revenue Code	272
Min. Negotiated Rate	$826.14
Max. Negotiated Rate	$1,571.28
Rate for Payer: Cash Price	$1,052.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,538.89
Rate for Payer: Health Management Network Commercial	$1,376.90
Rate for Payer: Kaiser Permanente Commercial	$1,020.52
Rate for Payer: Kaiser Permanente Medicaid	$826.14
Rate for Payer: MDX Hawaii PPO	$1,571.28
Rate for Payer: University Health Alliance Commercial	$1,180.73

PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC

Facility

$71,164.88

Service Code	MSDRG 273
Min. Negotiated Rate	$54,261.74
Max. Negotiated Rate	$71,164.88
Rate for Payer: AlohaCare Medicare	$54,261.74
Rate for Payer: Devoted Health Medicare	$59,687.91
Rate for Payer: Hawaii Medical Service Association Commercial	$54,313.07
Rate for Payer: Hawaii Medical Service Association Medicare	$54,261.74
Rate for Payer: Humana Medicare	$54,261.74
Rate for Payer: Kaiser Permanente Commercial	$71,164.88
Rate for Payer: Kaiser Permanente Medicare	$54,261.74
Rate for Payer: Ohana Health Plan Medicare	$54,261.74
Rate for Payer: UnitedHealthcare Medicare	$54,261.74

PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC

Facility

$56,781.82

Service Code	MSDRG 274
Min. Negotiated Rate	$38,233.70
Max. Negotiated Rate	$56,781.82
Rate for Payer: AlohaCare Medicare	$43,294.95
Rate for Payer: Devoted Health Medicare	$47,624.44
Rate for Payer: Hawaii Medical Service Association Commercial	$38,233.70
Rate for Payer: Hawaii Medical Service Association Medicare	$43,294.95
Rate for Payer: Humana Medicare	$43,294.95
Rate for Payer: Kaiser Permanente Commercial	$56,781.82
Rate for Payer: Kaiser Permanente Medicare	$43,294.95
Rate for Payer: Ohana Health Plan Medicare	$43,294.95
Rate for Payer: UnitedHealthcare Medicare	$43,294.95

PERCUTANEOUS ARTERIOVENOUS FISTULA CREATION, UPPER EXTREMITY, SINGLE ACCESS OF BOTH THE PERIPHERAL ARTERY AND PERIPHERAL VEIN, INCLUDING FISTULA MATURATION PROCEDURES (EG, TRANSLUMINAL BALLOON ANGIOPLASTY, COIL EMBOLIZATION) WHEN PERFORMED, INCLUDING ALL VASCULAR ACCESS, IMAGING GUIDANCE AND RADIOLOGIC SUPERVISION AND INTERPRETATION

Facility

$27,069.97

Service Code	CPT 36836
Hospital Revenue Code	360
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$27,069.97
Rate for Payer: AlohaCare Medicaid	$21,655.98
Rate for Payer: AlohaCare Medicare	$21,655.98
Rate for Payer: Devoted Health Medicare	$23,821.58
Rate for Payer: Hawaii Medical Service Association Commercial	$27,069.97
Rate for Payer: Hawaii Medical Service Association Medicare	$21,655.98
Rate for Payer: Humana Medicare	$21,655.98
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$21,655.98
Rate for Payer: Ohana Health Plan Medicaid	$23,821.58
Rate for Payer: Ohana Health Plan Medicare	$21,655.98
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$21,655.98

PERCUTANEOUS CARDIAC INTERVENTION W AMI

Facility

$10,520.62

Service Code	APR-DRG 1741
Min. Negotiated Rate	$10,520.62
Max. Negotiated Rate	$10,520.62
Rate for Payer: AlohaCare Medicaid	$10,520.62
Rate for Payer: Hawaii Medical Service Association ABD	$10,520.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,520.62
Rate for Payer: Kaiser Permanente Medicaid	$10,520.62
Rate for Payer: Ohana Health Plan Medicaid	$10,520.62
Rate for Payer: UnitedHealthcare Medicaid	$10,520.62

PERCUTANEOUS CARDIAC INTERVENTION W AMI

Facility

$11,278.42

Service Code	APR-DRG 1742
Min. Negotiated Rate	$11,278.42
Max. Negotiated Rate	$11,278.42
Rate for Payer: AlohaCare Medicaid	$11,278.42
Rate for Payer: Hawaii Medical Service Association ABD	$11,278.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,278.42
Rate for Payer: Kaiser Permanente Medicaid	$11,278.42
Rate for Payer: Ohana Health Plan Medicaid	$11,278.42
Rate for Payer: UnitedHealthcare Medicaid	$11,278.42

PERCUTANEOUS CARDIAC INTERVENTION W AMI

Facility

$18,983.10

Service Code	APR-DRG 1744
Min. Negotiated Rate	$18,983.10
Max. Negotiated Rate	$18,983.10
Rate for Payer: AlohaCare Medicaid	$18,983.10
Rate for Payer: Hawaii Medical Service Association ABD	$18,983.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18,983.10
Rate for Payer: Kaiser Permanente Medicaid	$18,983.10
Rate for Payer: Ohana Health Plan Medicaid	$18,983.10
Rate for Payer: UnitedHealthcare Medicaid	$18,983.10

PERCUTANEOUS CARDIAC INTERVENTION W AMI

Facility

$13,816.71

Service Code	APR-DRG 1743
Min. Negotiated Rate	$13,816.71
Max. Negotiated Rate	$13,816.71
Rate for Payer: AlohaCare Medicaid	$13,816.71
Rate for Payer: Hawaii Medical Service Association ABD	$13,816.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,816.71
Rate for Payer: Kaiser Permanente Medicaid	$13,816.71
Rate for Payer: Ohana Health Plan Medicaid	$13,816.71
Rate for Payer: UnitedHealthcare Medicaid	$13,816.71

PERCUTANEOUS CARDIAC INTERVENTION W/O AMI

Facility

$10,591.31

Service Code	APR-DRG 1751
Min. Negotiated Rate	$10,591.31
Max. Negotiated Rate	$10,591.31
Rate for Payer: AlohaCare Medicaid	$10,591.31
Rate for Payer: Hawaii Medical Service Association ABD	$10,591.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,591.31
Rate for Payer: Kaiser Permanente Medicaid	$10,591.31
Rate for Payer: Ohana Health Plan Medicaid	$10,591.31
Rate for Payer: UnitedHealthcare Medicaid	$10,591.31

PERCUTANEOUS CARDIAC INTERVENTION W/O AMI

Facility

$21,234.83

Service Code	APR-DRG 1754
Min. Negotiated Rate	$21,234.83
Max. Negotiated Rate	$21,234.83
Rate for Payer: AlohaCare Medicaid	$21,234.83
Rate for Payer: Hawaii Medical Service Association ABD	$21,234.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21,234.83
Rate for Payer: Kaiser Permanente Medicaid	$21,234.83
Rate for Payer: Ohana Health Plan Medicaid	$21,234.83
Rate for Payer: UnitedHealthcare Medicaid	$21,234.83

PERCUTANEOUS CARDIAC INTERVENTION W/O AMI

Facility

$11,608.92

Service Code	APR-DRG 1752
Min. Negotiated Rate	$11,608.92
Max. Negotiated Rate	$11,608.92
Rate for Payer: AlohaCare Medicaid	$11,608.92
Rate for Payer: Hawaii Medical Service Association ABD	$11,608.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,608.92
Rate for Payer: Kaiser Permanente Medicaid	$11,608.92
Rate for Payer: Ohana Health Plan Medicaid	$11,608.92
Rate for Payer: UnitedHealthcare Medicaid	$11,608.92

PERCUTANEOUS CARDIAC INTERVENTION W/O AMI

Facility

$14,169.50

Service Code	APR-DRG 1753
Min. Negotiated Rate	$14,169.50
Max. Negotiated Rate	$14,169.50
Rate for Payer: AlohaCare Medicaid	$14,169.50
Rate for Payer: Hawaii Medical Service Association ABD	$14,169.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14,169.50
Rate for Payer: Kaiser Permanente Medicaid	$14,169.50
Rate for Payer: Ohana Health Plan Medicaid	$14,169.50
Rate for Payer: UnitedHealthcare Medicaid	$14,169.50

PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES

Facility

$58,025.55

Service Code	MSDRG 321
Min. Negotiated Rate	$35,786.04
Max. Negotiated Rate	$58,025.55
Rate for Payer: AlohaCare Medicare	$35,786.04
Rate for Payer: Devoted Health Medicare	$39,364.64
Rate for Payer: Hawaii Medical Service Association Commercial	$58,025.55
Rate for Payer: Hawaii Medical Service Association Medicare	$35,786.04
Rate for Payer: Humana Medicare	$35,786.04
Rate for Payer: Kaiser Permanente Commercial	$46,933.80
Rate for Payer: Kaiser Permanente Medicare	$35,786.04
Rate for Payer: Ohana Health Plan Medicare	$35,786.04
Rate for Payer: UnitedHealthcare Medicare	$35,786.04

PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility

$41,174.76

Service Code	MSDRG 322
Min. Negotiated Rate	$23,188.33
Max. Negotiated Rate	$41,174.76
Rate for Payer: AlohaCare Medicare	$23,188.33
Rate for Payer: Devoted Health Medicare	$25,507.16
Rate for Payer: Hawaii Medical Service Association Commercial	$41,174.76
Rate for Payer: Hawaii Medical Service Association Medicare	$23,188.33
Rate for Payer: Humana Medicare	$23,188.33
Rate for Payer: Kaiser Permanente Commercial	$30,411.75
Rate for Payer: Kaiser Permanente Medicare	$23,188.33
Rate for Payer: Ohana Health Plan Medicare	$23,188.33
Rate for Payer: UnitedHealthcare Medicare	$23,188.33

PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC

Facility

$48,816.68

Service Code	MSDRG 250
Min. Negotiated Rate	$28,705.91
Max. Negotiated Rate	$48,816.68
Rate for Payer: AlohaCare Medicare	$28,705.91
Rate for Payer: Devoted Health Medicare	$31,576.50
Rate for Payer: Hawaii Medical Service Association Commercial	$48,816.68
Rate for Payer: Hawaii Medical Service Association Medicare	$28,705.91
Rate for Payer: Humana Medicare	$28,705.91
Rate for Payer: Kaiser Permanente Commercial	$37,648.12
Rate for Payer: Kaiser Permanente Medicare	$28,705.91
Rate for Payer: Ohana Health Plan Medicare	$28,705.91
Rate for Payer: UnitedHealthcare Medicare	$28,705.91

PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC

Facility

$36,353.36

Service Code	MSDRG 251
Min. Negotiated Rate	$19,656.81
Max. Negotiated Rate	$36,353.36
Rate for Payer: AlohaCare Medicare	$19,656.81
Rate for Payer: Devoted Health Medicare	$21,622.49
Rate for Payer: Hawaii Medical Service Association Commercial	$36,353.36
Rate for Payer: Hawaii Medical Service Association Medicare	$19,656.81
Rate for Payer: Humana Medicare	$19,656.81
Rate for Payer: Kaiser Permanente Commercial	$25,780.12
Rate for Payer: Kaiser Permanente Medicare	$19,656.81
Rate for Payer: Ohana Health Plan Medicare	$19,656.81
Rate for Payer: UnitedHealthcare Medicare	$19,656.81

PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITH MCC

Facility

$59,315.85

Service Code	MSDRG 359
Min. Negotiated Rate	$45,227.10
Max. Negotiated Rate	$59,315.85
Rate for Payer: AlohaCare Medicare	$45,227.10
Rate for Payer: Devoted Health Medicare	$49,749.81
Rate for Payer: Hawaii Medical Service Association Commercial	$58,025.55
Rate for Payer: Hawaii Medical Service Association Medicare	$45,227.10
Rate for Payer: Humana Medicare	$45,227.10
Rate for Payer: Kaiser Permanente Commercial	$59,315.85
Rate for Payer: Kaiser Permanente Medicare	$45,227.10
Rate for Payer: Ohana Health Plan Medicare	$45,227.10
Rate for Payer: UnitedHealthcare Medicare	$45,227.10

Know your out-of-pocket cost for care.

All Charges