Kona Community Hospital

All Charges

Charge

Type

Setting

Price

POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS

Facility

$3,804.26

Service Code	APR-DRG 7212
Min. Negotiated Rate	$3,804.26
Max. Negotiated Rate	$3,804.26
Rate for Payer: AlohaCare Medicaid	$3,804.26
Rate for Payer: Hawaii Medical Service Association ABD	$3,804.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,804.26
Rate for Payer: Kaiser Permanente Medicaid	$3,804.26
Rate for Payer: Ohana Health Plan Medicaid	$3,804.26
Rate for Payer: UnitedHealthcare Medicaid	$3,804.26

POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS

Facility

$6,054.09

Service Code	APR-DRG 7213
Min. Negotiated Rate	$6,054.09
Max. Negotiated Rate	$6,054.09
Rate for Payer: AlohaCare Medicaid	$6,054.09
Rate for Payer: Hawaii Medical Service Association ABD	$6,054.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,054.09
Rate for Payer: Kaiser Permanente Medicaid	$6,054.09
Rate for Payer: Ohana Health Plan Medicaid	$6,054.09
Rate for Payer: UnitedHealthcare Medicaid	$6,054.09

POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE

Facility

$6,938.61

Service Code	APR-DRG 7112
Min. Negotiated Rate	$6,938.61
Max. Negotiated Rate	$6,938.61
Rate for Payer: AlohaCare Medicaid	$6,938.61
Rate for Payer: Hawaii Medical Service Association ABD	$6,938.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,938.61
Rate for Payer: Kaiser Permanente Medicaid	$6,938.61
Rate for Payer: Ohana Health Plan Medicaid	$6,938.61
Rate for Payer: UnitedHealthcare Medicaid	$6,938.61

POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE

Facility

$21,804.77

Service Code	APR-DRG 7114
Min. Negotiated Rate	$21,804.77
Max. Negotiated Rate	$21,804.77
Rate for Payer: AlohaCare Medicaid	$21,804.77
Rate for Payer: Hawaii Medical Service Association ABD	$21,804.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21,804.77
Rate for Payer: Kaiser Permanente Medicaid	$21,804.77
Rate for Payer: Ohana Health Plan Medicaid	$21,804.77
Rate for Payer: UnitedHealthcare Medicaid	$21,804.77

POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE

Facility

$11,638.85

Service Code	APR-DRG 7113
Min. Negotiated Rate	$11,638.85
Max. Negotiated Rate	$11,638.85
Rate for Payer: AlohaCare Medicaid	$11,638.85
Rate for Payer: Hawaii Medical Service Association ABD	$11,638.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,638.85
Rate for Payer: Kaiser Permanente Medicaid	$11,638.85
Rate for Payer: Ohana Health Plan Medicaid	$11,638.85
Rate for Payer: UnitedHealthcare Medicaid	$11,638.85

POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE

Facility

$5,365.07

Service Code	APR-DRG 7111
Min. Negotiated Rate	$5,365.07
Max. Negotiated Rate	$5,365.07
Rate for Payer: AlohaCare Medicaid	$5,365.07
Rate for Payer: Hawaii Medical Service Association ABD	$5,365.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,365.07
Rate for Payer: Kaiser Permanente Medicaid	$5,365.07
Rate for Payer: Ohana Health Plan Medicaid	$5,365.07
Rate for Payer: UnitedHealthcare Medicaid	$5,365.07

POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES

Facility

$29,149.05

Service Code	MSDRG 769
Min. Negotiated Rate	$22,225.55
Max. Negotiated Rate	$29,149.05
Rate for Payer: AlohaCare Medicare	$22,225.55
Rate for Payer: Devoted Health Medicare	$24,448.10
Rate for Payer: Hawaii Medical Service Association Commercial	$25,553.42
Rate for Payer: Hawaii Medical Service Association Medicare	$22,225.55
Rate for Payer: Humana Medicare	$22,225.55
Rate for Payer: Kaiser Permanente Commercial	$29,149.05
Rate for Payer: Kaiser Permanente Medicare	$22,225.55
Rate for Payer: Ohana Health Plan Medicare	$22,225.55
Rate for Payer: UnitedHealthcare Medicare	$22,225.55

POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES

Facility

$11,293.58

Service Code	MSDRG 776
Min. Negotiated Rate	$8,611.12
Max. Negotiated Rate	$11,293.58
Rate for Payer: AlohaCare Medicare	$8,611.12
Rate for Payer: Devoted Health Medicare	$9,472.23
Rate for Payer: Hawaii Medical Service Association Commercial	$9,763.33
Rate for Payer: Hawaii Medical Service Association Medicare	$8,611.12
Rate for Payer: Humana Medicare	$8,611.12
Rate for Payer: Kaiser Permanente Commercial	$11,293.58
Rate for Payer: Kaiser Permanente Medicare	$8,611.12
Rate for Payer: Ohana Health Plan Medicare	$8,611.12
Rate for Payer: UnitedHealthcare Medicare	$8,611.12

POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE

Facility

$6,930.33

Service Code	APR-DRG 5614
Min. Negotiated Rate	$6,930.33
Max. Negotiated Rate	$6,930.33
Rate for Payer: AlohaCare Medicaid	$6,930.33
Rate for Payer: Hawaii Medical Service Association ABD	$6,930.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,930.33
Rate for Payer: Kaiser Permanente Medicaid	$6,930.33
Rate for Payer: Ohana Health Plan Medicaid	$6,930.33
Rate for Payer: UnitedHealthcare Medicaid	$6,930.33

POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE

Facility

$2,247.91

Service Code	APR-DRG 5612
Min. Negotiated Rate	$2,247.91
Max. Negotiated Rate	$2,247.91
Rate for Payer: AlohaCare Medicaid	$2,247.91
Rate for Payer: Hawaii Medical Service Association ABD	$2,247.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,247.91
Rate for Payer: Kaiser Permanente Medicaid	$2,247.91
Rate for Payer: Ohana Health Plan Medicaid	$2,247.91
Rate for Payer: UnitedHealthcare Medicaid	$2,247.91

POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE

Facility

$1,838.45

Service Code	APR-DRG 5611
Min. Negotiated Rate	$1,838.45
Max. Negotiated Rate	$1,838.45
Rate for Payer: AlohaCare Medicaid	$1,838.45
Rate for Payer: Hawaii Medical Service Association ABD	$1,838.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,838.45
Rate for Payer: Kaiser Permanente Medicaid	$1,838.45
Rate for Payer: Ohana Health Plan Medicaid	$1,838.45
Rate for Payer: UnitedHealthcare Medicaid	$1,838.45

POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE

Facility

$3,219.68

Service Code	APR-DRG 5613
Min. Negotiated Rate	$3,219.68
Max. Negotiated Rate	$3,219.68
Rate for Payer: AlohaCare Medicaid	$3,219.68
Rate for Payer: Hawaii Medical Service Association ABD	$3,219.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,219.68
Rate for Payer: Kaiser Permanente Medicaid	$3,219.68
Rate for Payer: Ohana Health Plan Medicaid	$3,219.68
Rate for Payer: UnitedHealthcare Medicaid	$3,219.68

POSTPARTUM & POST ABORTION DIAGNOSIS W O.R. PROCEDURE

Facility

$3,559.09

Service Code	APR-DRG 5482
Min. Negotiated Rate	$3,559.09
Max. Negotiated Rate	$3,559.09
Rate for Payer: AlohaCare Medicaid	$3,559.09
Rate for Payer: Hawaii Medical Service Association ABD	$3,559.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,559.09
Rate for Payer: Kaiser Permanente Medicaid	$3,559.09
Rate for Payer: Ohana Health Plan Medicaid	$3,559.09
Rate for Payer: UnitedHealthcare Medicaid	$3,559.09

POSTPARTUM & POST ABORTION DIAGNOSIS W O.R. PROCEDURE

Facility

$6,594.73

Service Code	APR-DRG 5483
Min. Negotiated Rate	$6,594.73
Max. Negotiated Rate	$6,594.73
Rate for Payer: AlohaCare Medicaid	$6,594.73
Rate for Payer: Hawaii Medical Service Association ABD	$6,594.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,594.73
Rate for Payer: Kaiser Permanente Medicaid	$6,594.73
Rate for Payer: Ohana Health Plan Medicaid	$6,594.73
Rate for Payer: UnitedHealthcare Medicaid	$6,594.73

POSTPARTUM & POST ABORTION DIAGNOSIS W O.R. PROCEDURE

Facility

$14,741.35

Service Code	APR-DRG 5484
Min. Negotiated Rate	$14,741.35
Max. Negotiated Rate	$14,741.35
Rate for Payer: AlohaCare Medicaid	$14,741.35
Rate for Payer: Hawaii Medical Service Association ABD	$14,741.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14,741.35
Rate for Payer: Kaiser Permanente Medicaid	$14,741.35
Rate for Payer: Ohana Health Plan Medicaid	$14,741.35
Rate for Payer: UnitedHealthcare Medicaid	$14,741.35

POSTPARTUM & POST ABORTION DIAGNOSIS W O.R. PROCEDURE

Facility

$2,318.60

Service Code	APR-DRG 5481
Min. Negotiated Rate	$2,318.60
Max. Negotiated Rate	$2,318.60
Rate for Payer: AlohaCare Medicaid	$2,318.60
Rate for Payer: Hawaii Medical Service Association ABD	$2,318.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,318.60
Rate for Payer: Kaiser Permanente Medicaid	$2,318.60
Rate for Payer: Ohana Health Plan Medicaid	$2,318.60
Rate for Payer: UnitedHealthcare Medicaid	$2,318.60

POTASSIUM CHLORID-D5-0.45%NACL 40 MEQ/L IV SOLP

Facility

$57.96

Service Code	HCPCS J3480
Hospital Revenue Code	250
Min. Negotiated Rate	$49.27
Max. Negotiated Rate	$56.22
Rate for Payer: Cash Price	$37.67
Rate for Payer: Cash Price	$28.25
Rate for Payer: Health Management Network Commercial	$36.94
Rate for Payer: Health Management Network Commercial	$49.27
Rate for Payer: MDX Hawaii PPO	$42.16
Rate for Payer: MDX Hawaii PPO	$56.22

POTASSIUM CHLORID-D5-0.45%NACL 40 MEQ/L IV SOLP

Facility

$43.46

Service Code	HCPCS J3480
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$42.16
Rate for Payer: Cash Price	$28.25
Rate for Payer: Cash Price	$28.25
Rate for Payer: Cash Price	$37.67
Rate for Payer: Cash Price	$37.67
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Western Management Group Commercial	$41.29
Rate for Payer: Hawaii Western Management Group Commercial	$55.06
Rate for Payer: Health Management Network Commercial	$49.27
Rate for Payer: Health Management Network Commercial	$36.94
Rate for Payer: Kaiser Permanente Commercial	$36.51
Rate for Payer: Kaiser Permanente Commercial	$27.38
Rate for Payer: Kaiser Permanente Medicaid	$22.16
Rate for Payer: Kaiser Permanente Medicaid	$29.56
Rate for Payer: MDX Hawaii PPO	$56.22
Rate for Payer: MDX Hawaii PPO	$42.16
Rate for Payer: UnitedHealthcare Medicaid	$26.08
Rate for Payer: UnitedHealthcare Medicaid	$34.78
Rate for Payer: University Health Alliance Commercial	$42.25
Rate for Payer: University Health Alliance Commercial	$31.68

POTASSIUM CHLORIDE 10 MEQ PO CAP SR

Facility

$5.64

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$5.47
Rate for Payer: Cash Price	$3.67
Rate for Payer: Hawaii Western Management Group Commercial	$5.36
Rate for Payer: Health Management Network Commercial	$4.79
Rate for Payer: Kaiser Permanente Commercial	$3.55
Rate for Payer: Kaiser Permanente Medicaid	$2.88
Rate for Payer: MDX Hawaii PPO	$5.47
Rate for Payer: UnitedHealthcare Medicaid	$3.38
Rate for Payer: University Health Alliance Commercial	$4.11

POTASSIUM CHLORIDE 10 MEQ PO CAP SR

Facility

$5.64

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$5.47
Rate for Payer: Cash Price	$3.67
Rate for Payer: Health Management Network Commercial	$4.79
Rate for Payer: MDX Hawaii PPO	$5.47

POTASSIUM CHLORIDE 20 MEQ PO EXTENDED RELEASE TAB

Facility

$3.47

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$3.37
Rate for Payer: Cash Price	$2.26
Rate for Payer: Health Management Network Commercial	$2.95
Rate for Payer: MDX Hawaii PPO	$3.37

POTASSIUM CHLORIDE 20 MEQ PO EXTENDED RELEASE TAB

Facility

$3.47

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$3.37
Rate for Payer: Cash Price	$2.26
Rate for Payer: Hawaii Western Management Group Commercial	$3.30
Rate for Payer: Health Management Network Commercial	$2.95
Rate for Payer: Kaiser Permanente Commercial	$2.19
Rate for Payer: Kaiser Permanente Medicaid	$1.77
Rate for Payer: MDX Hawaii PPO	$3.37
Rate for Payer: UnitedHealthcare Medicaid	$2.08
Rate for Payer: University Health Alliance Commercial	$2.53

POTASSIUM CHLORIDE 20 MEQ PO PKT

Facility

$58.95

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$50.11
Max. Negotiated Rate	$57.18
Rate for Payer: Cash Price	$38.32
Rate for Payer: Cash Price	$5.60
Rate for Payer: Health Management Network Commercial	$7.33
Rate for Payer: Health Management Network Commercial	$50.11
Rate for Payer: MDX Hawaii PPO	$57.18
Rate for Payer: MDX Hawaii PPO	$8.36

POTASSIUM CHLORIDE 20 MEQ PO PKT

Facility

$58.95

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$30.06
Max. Negotiated Rate	$57.18
Rate for Payer: Cash Price	$38.32
Rate for Payer: Cash Price	$5.60
Rate for Payer: Hawaii Western Management Group Commercial	$56.00
Rate for Payer: Hawaii Western Management Group Commercial	$8.19
Rate for Payer: Health Management Network Commercial	$50.11
Rate for Payer: Health Management Network Commercial	$7.33
Rate for Payer: Kaiser Permanente Commercial	$37.14
Rate for Payer: Kaiser Permanente Commercial	$5.43
Rate for Payer: Kaiser Permanente Medicaid	$30.06
Rate for Payer: Kaiser Permanente Medicaid	$4.40
Rate for Payer: MDX Hawaii PPO	$57.18
Rate for Payer: MDX Hawaii PPO	$8.36
Rate for Payer: UnitedHealthcare Medicaid	$5.17
Rate for Payer: UnitedHealthcare Medicaid	$35.37
Rate for Payer: University Health Alliance Commercial	$42.97
Rate for Payer: University Health Alliance Commercial	$6.28

POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN

Facility

$21.04

Service Code	HCPCS J3480
Hospital Revenue Code	250
Min. Negotiated Rate	$17.88
Max. Negotiated Rate	$20.41
Rate for Payer: Cash Price	$13.68
Rate for Payer: Health Management Network Commercial	$17.88
Rate for Payer: MDX Hawaii PPO	$20.41

Know your out-of-pocket cost for care.

All Charges