Kona Community Hospital

All Charges

Charge

Type

Setting

Price

AA 5 % NO.6-D20W-LYTES NO.23 5 % IV SOLP

Facility

$396.82

Service Code	NDC 00338112504
Hospital Revenue Code	250
Min. Negotiated Rate	$337.30
Max. Negotiated Rate	$384.92
Rate for Payer: Cash Price	$257.93
Rate for Payer: Health Management Network Commercial	$337.30
Rate for Payer: MDX Hawaii PPO	$384.92

AA 5 % NO.6-D20W-LYTES NO.23 5 % IV SOLP

Facility

$396.82

Service Code	NDC 00338112504
Hospital Revenue Code	250
Min. Negotiated Rate	$202.38
Max. Negotiated Rate	$384.92
Rate for Payer: Cash Price	$257.93
Rate for Payer: Hawaii Western Management Group Commercial	$376.98
Rate for Payer: Health Management Network Commercial	$337.30
Rate for Payer: Kaiser Permanente Commercial	$250.00
Rate for Payer: Kaiser Permanente Medicaid	$202.38
Rate for Payer: MDX Hawaii PPO	$384.92
Rate for Payer: UnitedHealthcare Medicaid	$238.09
Rate for Payer: University Health Alliance Commercial	$289.24

AA 5 % NO.6-D20W-LYTES NO.23 5 % IV SOLP

Facility

$204.30

Service Code	NDC 00338114803
Hospital Revenue Code	250
Min. Negotiated Rate	$104.19
Max. Negotiated Rate	$198.17
Rate for Payer: Cash Price	$132.80
Rate for Payer: Hawaii Western Management Group Commercial	$194.09
Rate for Payer: Health Management Network Commercial	$173.66
Rate for Payer: Kaiser Permanente Commercial	$128.71
Rate for Payer: Kaiser Permanente Medicaid	$104.19
Rate for Payer: MDX Hawaii PPO	$198.17
Rate for Payer: UnitedHealthcare Medicaid	$122.58
Rate for Payer: University Health Alliance Commercial	$148.91

ABDOMINAL PAIN

Facility

$2,516.01

Service Code	APR-DRG 2511
Min. Negotiated Rate	$2,516.01
Max. Negotiated Rate	$2,516.01
Rate for Payer: AlohaCare Medicaid	$2,516.01
Rate for Payer: Hawaii Medical Service Association ABD	$2,516.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,516.01
Rate for Payer: Kaiser Permanente Medicaid	$2,516.01
Rate for Payer: Ohana Health Plan Medicaid	$2,516.01
Rate for Payer: UnitedHealthcare Medicaid	$2,516.01

ABDOMINAL PAIN

Facility

$4,147.50

Service Code	APR-DRG 2513
Min. Negotiated Rate	$4,147.50
Max. Negotiated Rate	$4,147.50
Rate for Payer: AlohaCare Medicaid	$4,147.50
Rate for Payer: Hawaii Medical Service Association ABD	$4,147.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,147.50
Rate for Payer: Kaiser Permanente Medicaid	$4,147.50
Rate for Payer: Ohana Health Plan Medicaid	$4,147.50
Rate for Payer: UnitedHealthcare Medicaid	$4,147.50

ABDOMINAL PAIN

Facility

$6,699.17

Service Code	APR-DRG 2514
Min. Negotiated Rate	$6,699.17
Max. Negotiated Rate	$6,699.17
Rate for Payer: AlohaCare Medicaid	$6,699.17
Rate for Payer: Hawaii Medical Service Association ABD	$6,699.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,699.17
Rate for Payer: Kaiser Permanente Medicaid	$6,699.17
Rate for Payer: Ohana Health Plan Medicaid	$6,699.17
Rate for Payer: UnitedHealthcare Medicaid	$6,699.17

ABDOMINAL PAIN

Facility

$3,184.02

Service Code	APR-DRG 2512
Min. Negotiated Rate	$3,184.02
Max. Negotiated Rate	$3,184.02
Rate for Payer: AlohaCare Medicaid	$3,184.02
Rate for Payer: Hawaii Medical Service Association ABD	$3,184.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,184.02
Rate for Payer: Kaiser Permanente Medicaid	$3,184.02
Rate for Payer: Ohana Health Plan Medicaid	$3,184.02
Rate for Payer: UnitedHealthcare Medicaid	$3,184.02

Ablator Apollo Rf 90 Multiport Ar-9811 [3643631]

Facility

$831.25

Hospital Charge Code	3643631
Hospital Revenue Code	272
Min. Negotiated Rate	$423.94
Max. Negotiated Rate	$806.31
Rate for Payer: Cash Price	$540.31
Rate for Payer: Hawaii Western Management Group Commercial	$789.69
Rate for Payer: Health Management Network Commercial	$706.56
Rate for Payer: Kaiser Permanente Commercial	$523.69
Rate for Payer: Kaiser Permanente Medicaid	$423.94
Rate for Payer: MDX Hawaii PPO	$806.31
Rate for Payer: University Health Alliance Commercial	$605.90

Ablator Apollo Rf 90 Multiport Ar-9811 [3643631]

Facility

$831.25

Hospital Charge Code	3643631
Hospital Revenue Code	272
Min. Negotiated Rate	$706.56
Max. Negotiated Rate	$806.31
Rate for Payer: Cash Price	$540.31
Rate for Payer: Health Management Network Commercial	$706.56
Rate for Payer: MDX Hawaii PPO	$806.31

Ablator Apollo Rf Xl90 Aspirating Ar-9821 [3643632]

Facility

$831.25

Hospital Charge Code	3643632
Hospital Revenue Code	272
Min. Negotiated Rate	$706.56
Max. Negotiated Rate	$806.31
Rate for Payer: Cash Price	$540.31
Rate for Payer: Health Management Network Commercial	$706.56
Rate for Payer: MDX Hawaii PPO	$806.31

Ablator Apollo Rf Xl90 Aspirating Ar-9821 [3643632]

Facility

$831.25

Hospital Charge Code	3643632
Hospital Revenue Code	272
Min. Negotiated Rate	$423.94
Max. Negotiated Rate	$806.31
Rate for Payer: Cash Price	$540.31
Rate for Payer: Hawaii Western Management Group Commercial	$789.69
Rate for Payer: Health Management Network Commercial	$706.56
Rate for Payer: Kaiser Permanente Commercial	$523.69
Rate for Payer: Kaiser Permanente Medicaid	$423.94
Rate for Payer: MDX Hawaii PPO	$806.31
Rate for Payer: University Health Alliance Commercial	$605.90

ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$3,300.55

Service Code	APR-DRG 5432
Min. Negotiated Rate	$3,300.55
Max. Negotiated Rate	$3,300.55
Rate for Payer: AlohaCare Medicaid	$3,300.55
Rate for Payer: Hawaii Medical Service Association ABD	$3,300.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,300.55
Rate for Payer: Kaiser Permanente Medicaid	$3,300.55
Rate for Payer: Ohana Health Plan Medicaid	$3,300.55
Rate for Payer: UnitedHealthcare Medicaid	$3,300.55

ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$12,697.85

Service Code	APR-DRG 5434
Min. Negotiated Rate	$12,697.85
Max. Negotiated Rate	$12,697.85
Rate for Payer: AlohaCare Medicaid	$12,697.85
Rate for Payer: Hawaii Medical Service Association ABD	$12,697.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,697.85
Rate for Payer: Kaiser Permanente Medicaid	$12,697.85
Rate for Payer: Ohana Health Plan Medicaid	$12,697.85
Rate for Payer: UnitedHealthcare Medicaid	$12,697.85

ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$2,696.86

Service Code	APR-DRG 5431
Min. Negotiated Rate	$2,696.86
Max. Negotiated Rate	$2,696.86
Rate for Payer: AlohaCare Medicaid	$2,696.86
Rate for Payer: Hawaii Medical Service Association ABD	$2,696.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,696.86
Rate for Payer: Kaiser Permanente Medicaid	$2,696.86
Rate for Payer: Ohana Health Plan Medicaid	$2,696.86
Rate for Payer: UnitedHealthcare Medicaid	$2,696.86

ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$4,503.47

Service Code	APR-DRG 5433
Min. Negotiated Rate	$4,503.47
Max. Negotiated Rate	$4,503.47
Rate for Payer: AlohaCare Medicaid	$4,503.47
Rate for Payer: Hawaii Medical Service Association ABD	$4,503.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,503.47
Rate for Payer: Kaiser Permanente Medicaid	$4,503.47
Rate for Payer: Ohana Health Plan Medicaid	$4,503.47
Rate for Payer: UnitedHealthcare Medicaid	$4,503.47

ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$17,296.58

Service Code	MSDRG 770
Min. Negotiated Rate	$10,944.58
Max. Negotiated Rate	$17,296.58
Rate for Payer: AlohaCare Medicare	$13,188.28
Rate for Payer: Devoted Health Medicare	$14,507.11
Rate for Payer: Hawaii Medical Service Association Commercial	$10,944.58
Rate for Payer: Hawaii Medical Service Association Medicare	$13,188.28
Rate for Payer: Humana Medicare	$13,188.28
Rate for Payer: Kaiser Permanente Commercial	$17,296.58
Rate for Payer: Kaiser Permanente Medicare	$13,188.28
Rate for Payer: Ohana Health Plan Medicare	$13,188.28
Rate for Payer: UnitedHealthcare Medicare	$13,188.28

ABORTION WITHOUT D&C

Facility

$12,300.98

Service Code	MSDRG 779
Min. Negotiated Rate	$7,473.17
Max. Negotiated Rate	$12,300.98
Rate for Payer: AlohaCare Medicare	$11,065.43
Rate for Payer: Devoted Health Medicare	$12,171.97
Rate for Payer: Hawaii Medical Service Association Commercial	$7,473.17
Rate for Payer: Hawaii Medical Service Association Medicare	$11,065.43
Rate for Payer: Humana Medicare	$11,065.43
Rate for Payer: Kaiser Permanente Commercial	$12,300.98
Rate for Payer: Kaiser Permanente Medicare	$11,065.43
Rate for Payer: Ohana Health Plan Medicare	$11,065.43
Rate for Payer: UnitedHealthcare Medicare	$11,065.43

ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$2,324.33

Service Code	APR-DRG 5642
Min. Negotiated Rate	$2,324.33
Max. Negotiated Rate	$2,324.33
Rate for Payer: AlohaCare Medicaid	$2,324.33
Rate for Payer: Hawaii Medical Service Association ABD	$2,324.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,324.33
Rate for Payer: Kaiser Permanente Medicaid	$2,324.33
Rate for Payer: Ohana Health Plan Medicaid	$2,324.33
Rate for Payer: UnitedHealthcare Medicaid	$2,324.33

ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$2,873.89

Service Code	APR-DRG 5643
Min. Negotiated Rate	$2,873.89
Max. Negotiated Rate	$2,873.89
Rate for Payer: AlohaCare Medicaid	$2,873.89
Rate for Payer: Hawaii Medical Service Association ABD	$2,873.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,873.89
Rate for Payer: Kaiser Permanente Medicaid	$2,873.89
Rate for Payer: Ohana Health Plan Medicaid	$2,873.89
Rate for Payer: UnitedHealthcare Medicaid	$2,873.89

ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$1,949.89

Service Code	APR-DRG 5641
Min. Negotiated Rate	$1,949.89
Max. Negotiated Rate	$1,949.89
Rate for Payer: AlohaCare Medicaid	$1,949.89
Rate for Payer: Hawaii Medical Service Association ABD	$1,949.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,949.89
Rate for Payer: Kaiser Permanente Medicaid	$1,949.89
Rate for Payer: Ohana Health Plan Medicaid	$1,949.89
Rate for Payer: UnitedHealthcare Medicaid	$1,949.89

ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$5,558.65

Service Code	APR-DRG 5644
Min. Negotiated Rate	$5,558.65
Max. Negotiated Rate	$5,558.65
Rate for Payer: AlohaCare Medicaid	$5,558.65
Rate for Payer: Hawaii Medical Service Association ABD	$5,558.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,558.65
Rate for Payer: Kaiser Permanente Medicaid	$5,558.65
Rate for Payer: Ohana Health Plan Medicaid	$5,558.65
Rate for Payer: UnitedHealthcare Medicaid	$5,558.65

Abthera Advanced Dressing Kit ABT1055 [3642571]

Facility

$3,297.82

Hospital Charge Code	3642571
Hospital Revenue Code	272
Min. Negotiated Rate	$1,681.89
Max. Negotiated Rate	$3,198.89
Rate for Payer: Cash Price	$2,143.58
Rate for Payer: Hawaii Western Management Group Commercial	$3,132.93
Rate for Payer: Health Management Network Commercial	$2,803.15
Rate for Payer: Kaiser Permanente Commercial	$2,077.63
Rate for Payer: Kaiser Permanente Medicaid	$1,681.89
Rate for Payer: MDX Hawaii PPO	$3,198.89
Rate for Payer: University Health Alliance Commercial	$2,403.78

Abthera Advanced Dressing Kit ABT1055 [3642571]

Facility

$3,297.82

Hospital Charge Code	3642571
Hospital Revenue Code	272
Min. Negotiated Rate	$2,803.15
Max. Negotiated Rate	$3,198.89
Rate for Payer: Cash Price	$2,143.58
Rate for Payer: Health Management Network Commercial	$2,803.15
Rate for Payer: MDX Hawaii PPO	$3,198.89

ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN

Facility

$48.78

Service Code	HCPCS J0136
Hospital Revenue Code	636
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$47.32
Rate for Payer: Cash Price	$31.71
Rate for Payer: Cash Price	$31.71
Rate for Payer: Hawaii Medical Service Association ABD	$0.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.05
Rate for Payer: Hawaii Western Management Group Commercial	$46.34
Rate for Payer: Health Management Network Commercial	$41.46
Rate for Payer: Kaiser Permanente Commercial	$30.73
Rate for Payer: Kaiser Permanente Medicaid	$24.88
Rate for Payer: MDX Hawaii PPO	$47.32
Rate for Payer: UnitedHealthcare Medicaid	$29.27
Rate for Payer: University Health Alliance Commercial	$35.56

ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN

Facility

$56.03

Service Code	HCPCS J0134
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$54.35
Rate for Payer: Cash Price	$36.42
Rate for Payer: Cash Price	$36.42
Rate for Payer: Hawaii Medical Service Association ABD	$0.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.06
Rate for Payer: Hawaii Western Management Group Commercial	$53.23
Rate for Payer: Health Management Network Commercial	$47.63
Rate for Payer: Kaiser Permanente Commercial	$35.30
Rate for Payer: Kaiser Permanente Medicaid	$28.58
Rate for Payer: MDX Hawaii PPO	$54.35
Rate for Payer: UnitedHealthcare Medicaid	$33.62
Rate for Payer: University Health Alliance Commercial	$40.84

Know your out-of-pocket cost for care.

All Charges