Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Reamer Tube For Hollow Reamers 309.068 [3623762]

Facility

$1,283.66

Service Code	HCPCS C1713
Hospital Charge Code	3623762
Hospital Revenue Code	278
Min. Negotiated Rate	$654.67
Max. Negotiated Rate	$1,245.15
Rate for Payer: Cash Price	$834.38
Rate for Payer: Hawaii Western Management Group Commercial	$898.56
Rate for Payer: Health Management Network Commercial	$1,091.11
Rate for Payer: Kaiser Permanente Commercial	$808.71
Rate for Payer: Kaiser Permanente Medicaid	$654.67
Rate for Payer: MDX Hawaii PPO	$1,245.15
Rate for Payer: University Health Alliance Commercial	$718.85

Reamer Tube For Hollow Reamers 309.068 [3623762]

Facility

$1,283.66

Service Code	HCPCS C1713
Hospital Charge Code	3623762
Hospital Revenue Code	278
Min. Negotiated Rate	$718.85
Max. Negotiated Rate	$1,245.15
Rate for Payer: Cash Price	$834.38
Rate for Payer: Hawaii Western Management Group Commercial	$898.56
Rate for Payer: Health Management Network Commercial	$1,091.11
Rate for Payer: MDX Hawaii PPO	$1,245.15
Rate for Payer: University Health Alliance Commercial	$718.85

Reamer Tube for Hollow Reamers 309.280 [3623768]

Facility

$1,620.90

Hospital Charge Code	3623768
Hospital Revenue Code	272
Min. Negotiated Rate	$826.66
Max. Negotiated Rate	$1,572.27
Rate for Payer: Cash Price	$1,053.58
Rate for Payer: Hawaii Western Management Group Commercial	$1,539.86
Rate for Payer: Health Management Network Commercial	$1,377.77
Rate for Payer: Kaiser Permanente Commercial	$1,021.17
Rate for Payer: Kaiser Permanente Medicaid	$826.66
Rate for Payer: MDX Hawaii PPO	$1,572.27
Rate for Payer: University Health Alliance Commercial	$1,181.47

Reamer Tube for Hollow Reamers 309.280 [3623768]

Facility

$1,620.90

Hospital Charge Code	3623768
Hospital Revenue Code	272
Min. Negotiated Rate	$1,377.77
Max. Negotiated Rate	$1,572.27
Rate for Payer: Cash Price	$1,053.58
Rate for Payer: Health Management Network Commercial	$1,377.77
Rate for Payer: MDX Hawaii PPO	$1,572.27

Reamer Tube for Hollow Reamers 309.480 [3623770]

Facility

$2,039.10

Hospital Charge Code	3623770
Hospital Revenue Code	272
Min. Negotiated Rate	$1,039.94
Max. Negotiated Rate	$1,977.93
Rate for Payer: Cash Price	$1,325.42
Rate for Payer: Hawaii Western Management Group Commercial	$1,937.14
Rate for Payer: Health Management Network Commercial	$1,733.23
Rate for Payer: Kaiser Permanente Commercial	$1,284.63
Rate for Payer: Kaiser Permanente Medicaid	$1,039.94
Rate for Payer: MDX Hawaii PPO	$1,977.93
Rate for Payer: University Health Alliance Commercial	$1,486.30

Reamer Tube for Hollow Reamers 309.480 [3623770]

Facility

$2,039.10

Hospital Charge Code	3623770
Hospital Revenue Code	272
Min. Negotiated Rate	$1,733.23
Max. Negotiated Rate	$1,977.93
Rate for Payer: Cash Price	$1,325.42
Rate for Payer: Health Management Network Commercial	$1,733.23
Rate for Payer: MDX Hawaii PPO	$1,977.93

Reaming Rod 3.8mm Ball Tip 3.0mm/950mm 03.233.010S [3644364]

Facility

$1,328.66

Hospital Charge Code	3644364
Hospital Revenue Code	272
Min. Negotiated Rate	$1,129.36
Max. Negotiated Rate	$1,288.80
Rate for Payer: Cash Price	$863.63
Rate for Payer: Health Management Network Commercial	$1,129.36
Rate for Payer: MDX Hawaii PPO	$1,288.80

Reaming Rod 3.8mm Ball Tip 3.0mm/950mm 03.233.010S [3644364]

Facility

$1,328.66

Hospital Charge Code	3644364
Hospital Revenue Code	272
Min. Negotiated Rate	$677.62
Max. Negotiated Rate	$1,288.80
Rate for Payer: Cash Price	$863.63
Rate for Payer: Hawaii Western Management Group Commercial	$1,262.23
Rate for Payer: Health Management Network Commercial	$1,129.36
Rate for Payer: Kaiser Permanente Commercial	$837.06
Rate for Payer: Kaiser Permanente Medicaid	$677.62
Rate for Payer: MDX Hawaii PPO	$1,288.80
Rate for Payer: University Health Alliance Commercial	$968.46

RECONSTRUCTION (ADVANCEMENT), POSTERIOR TIBIAL TENDON WITH EXCISION OF ACCESSORY TARSAL NAVICULAR BONE (EG, KIDNER TYPE PROCEDURE)

Facility

$9,429.30

Service Code	CPT 28238
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
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	$521.33
Rate for Payer: UnitedHealthcare Medicare	$8,572.09
Rate for Payer: University Health Alliance Commercial	$6,743.44

RECTAL RESECTION WITH CC

Facility

$72,441.54

Service Code	MSDRG 333
Min. Negotiated Rate	$30,806.41
Max. Negotiated Rate	$72,441.54
Rate for Payer: AlohaCare Medicare	$30,806.41
Rate for Payer: Devoted Health Medicare	$33,887.05
Rate for Payer: Hawaii Medical Service Association Commercial	$72,441.54
Rate for Payer: Hawaii Medical Service Association Medicare	$30,806.41
Rate for Payer: Humana Medicare	$30,806.41
Rate for Payer: Kaiser Permanente Commercial	$40,402.95
Rate for Payer: Kaiser Permanente Medicare	$30,806.41
Rate for Payer: Ohana Health Plan Medicare	$30,806.41
Rate for Payer: UnitedHealthcare Medicare	$30,806.41

RECTAL RESECTION WITH MCC

Facility

$72,441.54

Service Code	MSDRG 332
Min. Negotiated Rate	$47,622.23
Max. Negotiated Rate	$72,441.54
Rate for Payer: AlohaCare Medicare	$47,622.23
Rate for Payer: Devoted Health Medicare	$52,384.45
Rate for Payer: Hawaii Medical Service Association Commercial	$72,441.54
Rate for Payer: Hawaii Medical Service Association Medicare	$47,622.23
Rate for Payer: Humana Medicare	$47,622.23
Rate for Payer: Kaiser Permanente Commercial	$62,457.07
Rate for Payer: Kaiser Permanente Medicare	$47,622.23
Rate for Payer: Ohana Health Plan Medicare	$47,622.23
Rate for Payer: UnitedHealthcare Medicare	$47,622.23

RECTAL RESECTION WITHOUT CC/MCC

Facility

$34,665.87

Service Code	MSDRG 334
Min. Negotiated Rate	$21,542.91
Max. Negotiated Rate	$34,665.87
Rate for Payer: AlohaCare Medicare	$21,542.91
Rate for Payer: Devoted Health Medicare	$23,697.20
Rate for Payer: Hawaii Medical Service Association Commercial	$34,665.87
Rate for Payer: Hawaii Medical Service Association Medicare	$21,542.91
Rate for Payer: Humana Medicare	$21,542.91
Rate for Payer: Kaiser Permanente Commercial	$28,253.78
Rate for Payer: Kaiser Permanente Medicare	$21,542.91
Rate for Payer: Ohana Health Plan Medicare	$21,542.91
Rate for Payer: UnitedHealthcare Medicare	$21,542.91

RED BLOOD CELL DISORDERS WITH MCC

Facility

$31,580.17

Service Code	MSDRG 811
Min. Negotiated Rate	$18,470.43
Max. Negotiated Rate	$31,580.17
Rate for Payer: AlohaCare Medicare	$18,470.43
Rate for Payer: Devoted Health Medicare	$20,317.47
Rate for Payer: Hawaii Medical Service Association Commercial	$31,580.17
Rate for Payer: Hawaii Medical Service Association Medicare	$18,470.43
Rate for Payer: Humana Medicare	$18,470.43
Rate for Payer: Kaiser Permanente Commercial	$24,224.17
Rate for Payer: Kaiser Permanente Medicare	$18,470.43
Rate for Payer: Ohana Health Plan Medicare	$18,470.43
Rate for Payer: UnitedHealthcare Medicare	$18,470.43

RED BLOOD CELL DISORDERS WITHOUT MCC

Facility

$16,923.11

Service Code	MSDRG 812
Min. Negotiated Rate	$12,076.87
Max. Negotiated Rate	$16,923.11
Rate for Payer: AlohaCare Medicare	$12,076.87
Rate for Payer: Devoted Health Medicare	$13,284.56
Rate for Payer: Hawaii Medical Service Association Commercial	$16,923.11
Rate for Payer: Hawaii Medical Service Association Medicare	$12,076.87
Rate for Payer: Humana Medicare	$12,076.87
Rate for Payer: Kaiser Permanente Commercial	$15,838.95
Rate for Payer: Kaiser Permanente Medicare	$12,076.87
Rate for Payer: Ohana Health Plan Medicare	$12,076.87
Rate for Payer: UnitedHealthcare Medicare	$12,076.87

REDUCTION OF TORSION OF TESTIS, SURGICAL, WITH OR WITHOUT FIXATION OF CONTRALATERAL TESTIS

Facility

$10,679.55

Service Code	CPT 54600
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$10,679.55
Rate for Payer: AlohaCare Medicaid	$4,164.22
Rate for Payer: AlohaCare Medicare	$4,164.22
Rate for Payer: Devoted Health Medicare	$4,580.64
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	$4,164.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Humana Medicare	$4,164.22
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,164.22
Rate for Payer: Ohana Health Plan Medicaid	$4,580.64
Rate for Payer: Ohana Health Plan Medicare	$4,164.22
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,164.22
Rate for Payer: University Health Alliance Commercial	$10,679.55

REDUCTION OF VOLVULUS, INTUSSUSCEPTION, INTERNAL HERNIA, BY LAPAROTOMY

Facility

$2,837.00

Service Code	CPT 44050
Hospital Revenue Code	360
Min. Negotiated Rate	$548.52
Max. Negotiated Rate	$2,837.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$548.52

REFILLING & MAINTENANCE PORTABLE PUMP

Professional

Both

$430.00

Service Code	HCPCS 96521
Min. Negotiated Rate	$83.92
Max. Negotiated Rate	$365.50
Rate for Payer: AlohaCare Medicaid	$83.92
Rate for Payer: AlohaCare Medicare	$161.03
Rate for Payer: Cash Price	$279.50
Rate for Payer: Cash Price	$279.50
Rate for Payer: Devoted Health Medicare	$177.13
Rate for Payer: Hawaii Medical Service Association Medicare	$161.03
Rate for Payer: Health Management Network Commercial	$365.50
Rate for Payer: Kaiser Permanente Commercial	$193.24
Rate for Payer: Kaiser Permanente Medicaid	$193.24
Rate for Payer: Kaiser Permanente Medicare	$193.24
Rate for Payer: Ohana Health Plan Medicaid	$83.92
Rate for Payer: Ohana Health Plan Medicare	$161.03
Rate for Payer: UnitedHealthcare Medicaid	$83.92
Rate for Payer: UnitedHealthcare Medicare	$161.03

REGADENOSON 0.4 MG/5 ML IV SYR

Facility

$142.20

Service Code	HCPCS J2785
Hospital Revenue Code	250
Min. Negotiated Rate	$120.87
Max. Negotiated Rate	$137.93
Rate for Payer: Cash Price	$92.43
Rate for Payer: Cash Price	$65.52
Rate for Payer: Cash Price	$392.39
Rate for Payer: Health Management Network Commercial	$120.87
Rate for Payer: Health Management Network Commercial	$85.68
Rate for Payer: Health Management Network Commercial	$513.12
Rate for Payer: MDX Hawaii PPO	$97.78
Rate for Payer: MDX Hawaii PPO	$585.56
Rate for Payer: MDX Hawaii PPO	$137.93

REGADENOSON 0.4 MG/5 ML IV SYR

Facility

$142.20

Service Code	HCPCS J2785
Hospital Revenue Code	636
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$137.93
Rate for Payer: Cash Price	$92.43
Rate for Payer: Cash Price	$65.52
Rate for Payer: Cash Price	$65.52
Rate for Payer: Cash Price	$92.43
Rate for Payer: Cash Price	$392.39
Rate for Payer: Cash Price	$392.39
Rate for Payer: Hawaii Medical Service Association ABD	$2.89
Rate for Payer: Hawaii Medical Service Association ABD	$2.89
Rate for Payer: Hawaii Medical Service Association ABD	$2.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.89
Rate for Payer: Hawaii Western Management Group Commercial	$95.76
Rate for Payer: Hawaii Western Management Group Commercial	$573.49
Rate for Payer: Hawaii Western Management Group Commercial	$135.09
Rate for Payer: Health Management Network Commercial	$85.68
Rate for Payer: Health Management Network Commercial	$120.87
Rate for Payer: Health Management Network Commercial	$513.12
Rate for Payer: Kaiser Permanente Commercial	$63.50
Rate for Payer: Kaiser Permanente Commercial	$89.59
Rate for Payer: Kaiser Permanente Commercial	$380.31
Rate for Payer: Kaiser Permanente Medicaid	$51.41
Rate for Payer: Kaiser Permanente Medicaid	$307.87
Rate for Payer: Kaiser Permanente Medicaid	$72.52
Rate for Payer: MDX Hawaii PPO	$137.93
Rate for Payer: MDX Hawaii PPO	$97.78
Rate for Payer: MDX Hawaii PPO	$585.56
Rate for Payer: UnitedHealthcare Medicaid	$60.48
Rate for Payer: UnitedHealthcare Medicaid	$85.32
Rate for Payer: UnitedHealthcare Medicaid	$362.20
Rate for Payer: University Health Alliance Commercial	$73.47
Rate for Payer: University Health Alliance Commercial	$440.02
Rate for Payer: University Health Alliance Commercial	$103.65

REHABILITATION

Facility

$8,461.20

Service Code	APR-DRG 8603
Min. Negotiated Rate	$8,461.20
Max. Negotiated Rate	$8,461.20
Rate for Payer: AlohaCare Medicaid	$8,461.20
Rate for Payer: Hawaii Medical Service Association ABD	$8,461.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,461.20
Rate for Payer: Kaiser Permanente Medicaid	$8,461.20
Rate for Payer: Ohana Health Plan Medicaid	$8,461.20
Rate for Payer: UnitedHealthcare Medicaid	$8,461.20

REHABILITATION

Facility

$6,210.10

Service Code	APR-DRG 8602
Min. Negotiated Rate	$6,210.10
Max. Negotiated Rate	$6,210.10
Rate for Payer: AlohaCare Medicaid	$6,210.10
Rate for Payer: Hawaii Medical Service Association ABD	$6,210.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,210.10
Rate for Payer: Kaiser Permanente Medicaid	$6,210.10
Rate for Payer: Ohana Health Plan Medicaid	$6,210.10
Rate for Payer: UnitedHealthcare Medicaid	$6,210.10

REHABILITATION

Facility

$11,124.95

Service Code	APR-DRG 8604
Min. Negotiated Rate	$11,124.95
Max. Negotiated Rate	$11,124.95
Rate for Payer: AlohaCare Medicaid	$11,124.95
Rate for Payer: Hawaii Medical Service Association ABD	$11,124.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,124.95
Rate for Payer: Kaiser Permanente Medicaid	$11,124.95
Rate for Payer: Ohana Health Plan Medicaid	$11,124.95
Rate for Payer: UnitedHealthcare Medicaid	$11,124.95

REHABILITATION

Facility

$5,705.75

Service Code	APR-DRG 8601
Min. Negotiated Rate	$5,705.75
Max. Negotiated Rate	$5,705.75
Rate for Payer: AlohaCare Medicaid	$5,705.75
Rate for Payer: Hawaii Medical Service Association ABD	$5,705.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,705.75
Rate for Payer: Kaiser Permanente Medicaid	$5,705.75
Rate for Payer: Ohana Health Plan Medicaid	$5,705.75
Rate for Payer: UnitedHealthcare Medicaid	$5,705.75

REHABILITATION WITH CC/MCC

Facility

$26,713.35

Service Code	MSDRG 945
Min. Negotiated Rate	$9,932.08
Max. Negotiated Rate	$26,713.35
Rate for Payer: AlohaCare Medicare	$20,368.38
Rate for Payer: Devoted Health Medicare	$22,405.22
Rate for Payer: Hawaii Medical Service Association Commercial	$9,932.08
Rate for Payer: Hawaii Medical Service Association Medicare	$20,368.38
Rate for Payer: Humana Medicare	$20,368.38
Rate for Payer: Kaiser Permanente Commercial	$26,713.35
Rate for Payer: Kaiser Permanente Medicare	$20,368.38
Rate for Payer: Ohana Health Plan Medicare	$20,368.38
Rate for Payer: UnitedHealthcare Medicare	$20,368.38

REHABILITATION WITHOUT CC/MCC

Facility

$19,782.30

Service Code	MSDRG 946
Min. Negotiated Rate	$9,932.08
Max. Negotiated Rate	$19,782.30
Rate for Payer: AlohaCare Medicare	$15,083.60
Rate for Payer: Devoted Health Medicare	$16,591.96
Rate for Payer: Hawaii Medical Service Association Commercial	$9,932.08
Rate for Payer: Hawaii Medical Service Association Medicare	$15,083.60
Rate for Payer: Humana Medicare	$15,083.60
Rate for Payer: Kaiser Permanente Commercial	$19,782.30
Rate for Payer: Kaiser Permanente Medicare	$15,083.60
Rate for Payer: Ohana Health Plan Medicare	$15,083.60
Rate for Payer: UnitedHealthcare Medicare	$15,083.60

Know your out-of-pocket cost for care.

All Charges