Kona Community Hospital

All Charges

Charge

Type

Setting

Price

PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility

$41,646.68

Service Code	MSDRG 360
Min. Negotiated Rate	$31,754.72
Max. Negotiated Rate	$41,646.68
Rate for Payer: AlohaCare Medicare	$31,754.72
Rate for Payer: Devoted Health Medicare	$34,930.19
Rate for Payer: Hawaii Medical Service Association Commercial	$41,174.76
Rate for Payer: Hawaii Medical Service Association Medicare	$31,754.72
Rate for Payer: Humana Medicare	$31,754.72
Rate for Payer: Kaiser Permanente Commercial	$41,646.68
Rate for Payer: Kaiser Permanente Medicare	$31,754.72
Rate for Payer: Ohana Health Plan Medicare	$31,754.72
Rate for Payer: UnitedHealthcare Medicare	$31,754.72

PERCUTANEOUS CORONARY ATHERECTOMY WITHOUT INTRALUMINAL DEVICE

Facility

$48,816.68

Service Code	MSDRG 318
Min. Negotiated Rate	$31,858.64
Max. Negotiated Rate	$48,816.68
Rate for Payer: AlohaCare Medicare	$31,858.64
Rate for Payer: Devoted Health Medicare	$35,044.50
Rate for Payer: Hawaii Medical Service Association Commercial	$48,816.68
Rate for Payer: Hawaii Medical Service Association Medicare	$31,858.64
Rate for Payer: Humana Medicare	$31,858.64
Rate for Payer: Kaiser Permanente Commercial	$41,782.95
Rate for Payer: Kaiser Permanente Medicare	$31,858.64
Rate for Payer: Ohana Health Plan Medicare	$31,858.64
Rate for Payer: UnitedHealthcare Medicare	$31,858.64

PERCUTANEOUS INTRA & EXTRACRANIAL VASCULAR PROCEDURES

Facility

$24,330.33

Service Code	APR-DRG 0304
Min. Negotiated Rate	$24,330.33
Max. Negotiated Rate	$24,330.33
Rate for Payer: AlohaCare Medicaid	$24,330.33
Rate for Payer: Hawaii Medical Service Association ABD	$24,330.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24,330.33
Rate for Payer: Kaiser Permanente Medicaid	$24,330.33
Rate for Payer: Ohana Health Plan Medicaid	$24,330.33
Rate for Payer: UnitedHealthcare Medicaid	$24,330.33

PERCUTANEOUS INTRA & EXTRACRANIAL VASCULAR PROCEDURES

Facility

$18,159.71

Service Code	APR-DRG 0303
Min. Negotiated Rate	$18,159.71
Max. Negotiated Rate	$18,159.71
Rate for Payer: AlohaCare Medicaid	$18,159.71
Rate for Payer: Hawaii Medical Service Association ABD	$18,159.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18,159.71
Rate for Payer: Kaiser Permanente Medicaid	$18,159.71
Rate for Payer: Ohana Health Plan Medicaid	$18,159.71
Rate for Payer: UnitedHealthcare Medicaid	$18,159.71

PERCUTANEOUS INTRA & EXTRACRANIAL VASCULAR PROCEDURES

Facility

$12,268.65

Service Code	APR-DRG 0302
Min. Negotiated Rate	$12,268.65
Max. Negotiated Rate	$12,268.65
Rate for Payer: AlohaCare Medicaid	$12,268.65
Rate for Payer: Hawaii Medical Service Association ABD	$12,268.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,268.65
Rate for Payer: Kaiser Permanente Medicaid	$12,268.65
Rate for Payer: Ohana Health Plan Medicaid	$12,268.65
Rate for Payer: UnitedHealthcare Medicaid	$12,268.65

PERCUTANEOUS INTRA & EXTRACRANIAL VASCULAR PROCEDURES

Facility

$9,277.58

Service Code	APR-DRG 0301
Min. Negotiated Rate	$9,277.58
Max. Negotiated Rate	$9,277.58
Rate for Payer: AlohaCare Medicaid	$9,277.58
Rate for Payer: Hawaii Medical Service Association ABD	$9,277.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,277.58
Rate for Payer: Kaiser Permanente Medicaid	$9,277.58
Rate for Payer: Ohana Health Plan Medicaid	$9,277.58
Rate for Payer: UnitedHealthcare Medicaid	$9,277.58

PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE, PROXIMAL END, NECK

Facility

$14,715.00

Service Code	CPT 27235
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$14,715.00
Rate for Payer: AlohaCare Medicaid	$8,572.09
Rate for Payer: AlohaCare Medicare	$8,572.09
Rate for Payer: Devoted Health Medicare	$9,429.30
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	$8,572.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,154.45
Rate for Payer: Humana Medicare	$8,572.09
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$8,572.09
Rate for Payer: Ohana Health Plan Medicaid	$9,429.30
Rate for Payer: Ohana Health Plan Medicare	$8,572.09
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$8,572.09

PERCUTANEOUS SKELETAL FIXATION OF FRACTURE GREAT TOE, PHALANX OR PHALANGES, WITH MANIPULATION

Facility

$6,183.00

Service Code	CPT 28496
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$3,865.36
Rate for Payer: AlohaCare Medicare	$3,865.36
Rate for Payer: Devoted Health Medicare	$4,251.90
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	$3,865.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,865.36
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,865.36
Rate for Payer: Ohana Health Plan Medicaid	$4,251.90
Rate for Payer: Ohana Health Plan Medicare	$3,865.36
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,865.36
Rate for Payer: University Health Alliance Commercial	$5,160.40

PERCUTANEOUS SKELETAL FIXATION OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL, WITH MANIPULATION

Facility

$9,416.00

Service Code	CPT 24566
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$9,416.00
Rate for Payer: AlohaCare Medicaid	$1,899.59
Rate for Payer: AlohaCare Medicare	$1,899.59
Rate for Payer: Devoted Health Medicare	$2,089.55
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	$1,899.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Humana Medicare	$1,899.59
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,899.59
Rate for Payer: Ohana Health Plan Medicaid	$2,089.55
Rate for Payer: Ohana Health Plan Medicare	$1,899.59
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,899.59
Rate for Payer: University Health Alliance Commercial	$5,160.40

PERCUTANEOUS SKELETAL FIXATION OF METACARPAL FRACTURE, EACH BONE

Facility

$10,679.55

Service Code	CPT 26608
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$10,679.55
Rate for Payer: AlohaCare Medicaid	$3,865.36
Rate for Payer: AlohaCare Medicare	$3,865.36
Rate for Payer: Devoted Health Medicare	$4,251.90
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	$3,865.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,865.36
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,865.36
Rate for Payer: Ohana Health Plan Medicaid	$4,251.90
Rate for Payer: Ohana Health Plan Medicare	$3,865.36
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,865.36
Rate for Payer: University Health Alliance Commercial	$10,679.55

PERCUTANEOUS SKELETAL FIXATION OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTURE, WITH OR WITHOUT INTERCONDYLAR EXTENSION

Facility

$9,429.30

Service Code	CPT 24538
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$9,429.30
Rate for Payer: AlohaCare Medicaid	$8,572.09
Rate for Payer: AlohaCare Medicare	$8,572.09
Rate for Payer: Devoted Health Medicare	$9,429.30
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	$8,572.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Humana Medicare	$8,572.09
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$8,572.09
Rate for Payer: Ohana Health Plan Medicaid	$9,429.30
Rate for Payer: Ohana Health Plan Medicare	$8,572.09
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$8,572.09
Rate for Payer: University Health Alliance Commercial	$5,160.40

PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$23,335.01

Service Code	APR-DRG 1832
Min. Negotiated Rate	$23,335.01
Max. Negotiated Rate	$23,335.01
Rate for Payer: AlohaCare Medicaid	$23,335.01
Rate for Payer: Hawaii Medical Service Association ABD	$23,335.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23,335.01
Rate for Payer: Kaiser Permanente Medicaid	$23,335.01
Rate for Payer: Ohana Health Plan Medicaid	$23,335.01
Rate for Payer: UnitedHealthcare Medicaid	$23,335.01

PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$27,144.36

Service Code	APR-DRG 1833
Min. Negotiated Rate	$27,144.36
Max. Negotiated Rate	$27,144.36
Rate for Payer: AlohaCare Medicaid	$27,144.36
Rate for Payer: Hawaii Medical Service Association ABD	$27,144.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27,144.36
Rate for Payer: Kaiser Permanente Medicaid	$27,144.36
Rate for Payer: Ohana Health Plan Medicaid	$27,144.36
Rate for Payer: UnitedHealthcare Medicaid	$27,144.36

PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$21,807.96

Service Code	APR-DRG 1831
Min. Negotiated Rate	$21,807.96
Max. Negotiated Rate	$21,807.96
Rate for Payer: AlohaCare Medicaid	$21,807.96
Rate for Payer: Hawaii Medical Service Association ABD	$21,807.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21,807.96
Rate for Payer: Kaiser Permanente Medicaid	$21,807.96
Rate for Payer: Ohana Health Plan Medicaid	$21,807.96
Rate for Payer: UnitedHealthcare Medicaid	$21,807.96

PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$38,005.04

Service Code	APR-DRG 1834
Min. Negotiated Rate	$38,005.04
Max. Negotiated Rate	$38,005.04
Rate for Payer: AlohaCare Medicaid	$38,005.04
Rate for Payer: Hawaii Medical Service Association ABD	$38,005.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$38,005.04
Rate for Payer: Kaiser Permanente Medicaid	$38,005.04
Rate for Payer: Ohana Health Plan Medicaid	$38,005.04
Rate for Payer: UnitedHealthcare Medicaid	$38,005.04

PERFLUTREN LIPID MICROSPHERES 0.65 MG/ML IV SUSP

Facility

$907.28

Service Code	HCPCS Q9957
Hospital Revenue Code	250
Min. Negotiated Rate	$41.20
Max. Negotiated Rate	$880.06
Rate for Payer: Cash Price	$589.73
Rate for Payer: Cash Price	$589.73
Rate for Payer: Hawaii Medical Service Association ABD	$41.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$41.20
Rate for Payer: Hawaii Western Management Group Commercial	$861.92
Rate for Payer: Health Management Network Commercial	$771.19
Rate for Payer: Kaiser Permanente Commercial	$571.59
Rate for Payer: Kaiser Permanente Medicaid	$462.71
Rate for Payer: MDX Hawaii PPO	$880.06
Rate for Payer: UnitedHealthcare Medicaid	$544.37
Rate for Payer: University Health Alliance Commercial	$661.32

PERFLUTREN LIPID MICROSPHERES 0.65 MG/ML IV SUSP

Facility

$907.28

Service Code	HCPCS Q9957
Hospital Revenue Code	250
Min. Negotiated Rate	$771.19
Max. Negotiated Rate	$880.06
Rate for Payer: Cash Price	$589.73
Rate for Payer: Health Management Network Commercial	$771.19
Rate for Payer: MDX Hawaii PPO	$880.06

PERFLUTREN LIPID MICROSPHERES 1.1 MG/ML IV SUSP

Facility

$981.44

Service Code	HCPCS Q9957
Hospital Revenue Code	250
Min. Negotiated Rate	$834.22
Max. Negotiated Rate	$952.00
Rate for Payer: Cash Price	$637.94
Rate for Payer: Health Management Network Commercial	$834.22
Rate for Payer: MDX Hawaii PPO	$952.00

PERFLUTREN LIPID MICROSPHERES 1.1 MG/ML IV SUSP

Facility

$981.44

Service Code	HCPCS Q9957
Hospital Revenue Code	250
Min. Negotiated Rate	$41.20
Max. Negotiated Rate	$952.00
Rate for Payer: Cash Price	$637.94
Rate for Payer: Cash Price	$637.94
Rate for Payer: Hawaii Medical Service Association ABD	$41.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$41.20
Rate for Payer: Hawaii Western Management Group Commercial	$932.37
Rate for Payer: Health Management Network Commercial	$834.22
Rate for Payer: Kaiser Permanente Commercial	$618.31
Rate for Payer: Kaiser Permanente Medicaid	$500.53
Rate for Payer: MDX Hawaii PPO	$952.00
Rate for Payer: UnitedHealthcare Medicaid	$588.86
Rate for Payer: University Health Alliance Commercial	$715.37

PERINEOPLASTY, REPAIR OF PERINEUM, NONOBSTETRICAL (SEPARATE PROCEDURE)

Facility

$11,157.19

Service Code	CPT 56810
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,157.19
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	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$9,416.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,824.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
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	$11,157.19

PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS

Facility

$4,676.04

Service Code	APR-DRG 0483
Min. Negotiated Rate	$4,676.04
Max. Negotiated Rate	$4,676.04
Rate for Payer: AlohaCare Medicaid	$4,676.04
Rate for Payer: Hawaii Medical Service Association ABD	$4,676.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,676.04
Rate for Payer: Kaiser Permanente Medicaid	$4,676.04
Rate for Payer: Ohana Health Plan Medicaid	$4,676.04
Rate for Payer: UnitedHealthcare Medicaid	$4,676.04

PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS

Facility

$9,439.33

Service Code	APR-DRG 0484
Min. Negotiated Rate	$9,439.33
Max. Negotiated Rate	$9,439.33
Rate for Payer: AlohaCare Medicaid	$9,439.33
Rate for Payer: Hawaii Medical Service Association ABD	$9,439.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,439.33
Rate for Payer: Kaiser Permanente Medicaid	$9,439.33
Rate for Payer: Ohana Health Plan Medicaid	$9,439.33
Rate for Payer: UnitedHealthcare Medicaid	$9,439.33

PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS

Facility

$3,091.68

Service Code	APR-DRG 0481
Min. Negotiated Rate	$3,091.68
Max. Negotiated Rate	$3,091.68
Rate for Payer: AlohaCare Medicaid	$3,091.68
Rate for Payer: Hawaii Medical Service Association ABD	$3,091.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,091.68
Rate for Payer: Kaiser Permanente Medicaid	$3,091.68
Rate for Payer: Ohana Health Plan Medicaid	$3,091.68
Rate for Payer: UnitedHealthcare Medicaid	$3,091.68

PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS

Facility

$3,529.80

Service Code	APR-DRG 0482
Min. Negotiated Rate	$3,529.80
Max. Negotiated Rate	$3,529.80
Rate for Payer: AlohaCare Medicaid	$3,529.80
Rate for Payer: Hawaii Medical Service Association ABD	$3,529.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,529.80
Rate for Payer: Kaiser Permanente Medicaid	$3,529.80
Rate for Payer: Ohana Health Plan Medicaid	$3,529.80
Rate for Payer: UnitedHealthcare Medicaid	$3,529.80

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR

Facility

$59,086.26

Service Code	MSDRG 041
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$59,086.26
Rate for Payer: AlohaCare Medicare	$28,918.98
Rate for Payer: Devoted Health Medicare	$31,810.88
Rate for Payer: Hawaii Medical Service Association Commercial	$59,086.26
Rate for Payer: Hawaii Medical Service Association Medicare	$28,918.98
Rate for Payer: Humana Medicare	$28,918.98
Rate for Payer: Kaiser Permanente Commercial	$37,927.57
Rate for Payer: Kaiser Permanente Medicare	$28,918.98
Rate for Payer: Ohana Health Plan Medicare	$28,918.98
Rate for Payer: UnitedHealthcare Medicare	$28,918.98
Rate for Payer: University Health Alliance Commercial	$10,400.00

Know your out-of-pocket cost for care.

All Charges