Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Speed Drill Kit w/2.65mm Drill Bit DK265C [3641017]

Facility

$1,651.40

Hospital Charge Code	3641017
Hospital Revenue Code	272
Min. Negotiated Rate	$1,403.69
Max. Negotiated Rate	$1,601.86
Rate for Payer: Cash Price	$1,073.41
Rate for Payer: Health Management Network Commercial	$1,403.69
Rate for Payer: MDX Hawaii PPO	$1,601.86

Speedspiral 15x15 8a00-1515 [3643644]

Facility

$3,750.00

Service Code	HCPCS C1762
Hospital Charge Code	3643644
Hospital Revenue Code	278
Min. Negotiated Rate	$1,912.50
Max. Negotiated Rate	$3,637.50
Rate for Payer: Cash Price	$2,437.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,625.00
Rate for Payer: Health Management Network Commercial	$3,187.50
Rate for Payer: Kaiser Permanente Commercial	$2,362.50
Rate for Payer: Kaiser Permanente Medicaid	$1,912.50
Rate for Payer: MDX Hawaii PPO	$3,637.50
Rate for Payer: University Health Alliance Commercial	$2,100.00

Speedspiral 15x15 8a00-1515 [3643644]

Facility

$3,750.00

Service Code	HCPCS C1762
Hospital Charge Code	3643644
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,637.50
Rate for Payer: Cash Price	$2,437.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,625.00
Rate for Payer: Health Management Network Commercial	$3,187.50
Rate for Payer: MDX Hawaii PPO	$3,637.50
Rate for Payer: University Health Alliance Commercial	$2,100.00

SPINAL DISORDERS AND INJURIES WITH CC/MCC

Facility

$35,172.11

Service Code	MSDRG 052
Min. Negotiated Rate	$23,823.60
Max. Negotiated Rate	$35,172.11
Rate for Payer: AlohaCare Medicare	$23,823.60
Rate for Payer: Devoted Health Medicare	$26,205.96
Rate for Payer: Hawaii Medical Service Association Commercial	$35,172.11
Rate for Payer: Hawaii Medical Service Association Medicare	$23,823.60
Rate for Payer: Humana Medicare	$23,823.60
Rate for Payer: Kaiser Permanente Commercial	$30,718.80
Rate for Payer: Kaiser Permanente Medicare	$23,823.60
Rate for Payer: Ohana Health Plan Medicare	$23,823.60
Rate for Payer: UnitedHealthcare Medicare	$23,823.60

SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC

Facility

$35,172.11

Service Code	MSDRG 053
Min. Negotiated Rate	$12,879.20
Max. Negotiated Rate	$35,172.11
Rate for Payer: AlohaCare Medicare	$12,879.20
Rate for Payer: Devoted Health Medicare	$14,167.12
Rate for Payer: Hawaii Medical Service Association Commercial	$35,172.11
Rate for Payer: Hawaii Medical Service Association Medicare	$12,879.20
Rate for Payer: Humana Medicare	$12,879.20
Rate for Payer: Kaiser Permanente Commercial	$16,891.20
Rate for Payer: Kaiser Permanente Medicare	$12,879.20
Rate for Payer: Ohana Health Plan Medicare	$12,879.20
Rate for Payer: UnitedHealthcare Medicare	$12,879.20

SPINAL DISORDERS & INJURIES

Facility

$12,860.87

Service Code	APR-DRG 0404
Min. Negotiated Rate	$12,860.87
Max. Negotiated Rate	$12,860.87
Rate for Payer: AlohaCare Medicaid	$12,860.87
Rate for Payer: Hawaii Medical Service Association ABD	$12,860.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,860.87
Rate for Payer: Kaiser Permanente Medicaid	$12,860.87
Rate for Payer: Ohana Health Plan Medicaid	$12,860.87
Rate for Payer: UnitedHealthcare Medicaid	$12,860.87

SPINAL DISORDERS & INJURIES

Facility

$4,807.86

Service Code	APR-DRG 0401
Min. Negotiated Rate	$4,807.86
Max. Negotiated Rate	$4,807.86
Rate for Payer: AlohaCare Medicaid	$4,807.86
Rate for Payer: Hawaii Medical Service Association ABD	$4,807.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,807.86
Rate for Payer: Kaiser Permanente Medicaid	$4,807.86
Rate for Payer: Ohana Health Plan Medicaid	$4,807.86
Rate for Payer: UnitedHealthcare Medicaid	$4,807.86

SPINAL DISORDERS & INJURIES

Facility

$5,488.61

Service Code	APR-DRG 0402
Min. Negotiated Rate	$5,488.61
Max. Negotiated Rate	$5,488.61
Rate for Payer: AlohaCare Medicaid	$5,488.61
Rate for Payer: Hawaii Medical Service Association ABD	$5,488.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,488.61
Rate for Payer: Kaiser Permanente Medicaid	$5,488.61
Rate for Payer: Ohana Health Plan Medicaid	$5,488.61
Rate for Payer: UnitedHealthcare Medicaid	$5,488.61

SPINAL DISORDERS & INJURIES

Facility

$7,948.58

Service Code	APR-DRG 0403
Min. Negotiated Rate	$7,948.58
Max. Negotiated Rate	$7,948.58
Rate for Payer: AlohaCare Medicaid	$7,948.58
Rate for Payer: Hawaii Medical Service Association ABD	$7,948.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,948.58
Rate for Payer: Kaiser Permanente Medicaid	$7,948.58
Rate for Payer: Ohana Health Plan Medicaid	$7,948.58
Rate for Payer: UnitedHealthcare Medicaid	$7,948.58

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC

Facility

$139,627.74

Service Code	MSDRG 457
Min. Negotiated Rate	$78,431.26
Max. Negotiated Rate	$139,627.74
Rate for Payer: AlohaCare Medicare	$78,431.26
Rate for Payer: Devoted Health Medicare	$86,274.39
Rate for Payer: Hawaii Medical Service Association Commercial	$139,627.74
Rate for Payer: Hawaii Medical Service Association Medicare	$78,431.26
Rate for Payer: Humana Medicare	$78,431.26
Rate for Payer: Kaiser Permanente Commercial	$102,863.48
Rate for Payer: Kaiser Permanente Medicare	$78,431.26
Rate for Payer: Ohana Health Plan Medicare	$78,431.26
Rate for Payer: UnitedHealthcare Medicare	$78,431.26

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC

Facility

$144,958.65

Service Code	MSDRG 456
Min. Negotiated Rate	$110,527.95
Max. Negotiated Rate	$144,958.65
Rate for Payer: AlohaCare Medicare	$110,527.95
Rate for Payer: Devoted Health Medicare	$121,580.74
Rate for Payer: Hawaii Medical Service Association Commercial	$139,627.74
Rate for Payer: Hawaii Medical Service Association Medicare	$110,527.95
Rate for Payer: Humana Medicare	$110,527.95
Rate for Payer: Kaiser Permanente Commercial	$144,958.65
Rate for Payer: Kaiser Permanente Medicare	$110,527.95
Rate for Payer: Ohana Health Plan Medicare	$110,527.95
Rate for Payer: UnitedHealthcare Medicare	$110,527.95

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC

Facility

$139,627.74

Service Code	MSDRG 458
Min. Negotiated Rate	$54,881.21
Max. Negotiated Rate	$139,627.74
Rate for Payer: AlohaCare Medicare	$54,881.21
Rate for Payer: Devoted Health Medicare	$60,369.33
Rate for Payer: Hawaii Medical Service Association Commercial	$139,627.74
Rate for Payer: Hawaii Medical Service Association Medicare	$54,881.21
Rate for Payer: Humana Medicare	$54,881.21
Rate for Payer: Kaiser Permanente Commercial	$71,977.35
Rate for Payer: Kaiser Permanente Medicare	$54,881.21
Rate for Payer: Ohana Health Plan Medicare	$54,881.21
Rate for Payer: UnitedHealthcare Medicare	$54,881.21

SPINAL PROCEDURES

Facility

$7,516.82

Service Code	APR-DRG 0231
Min. Negotiated Rate	$7,516.82
Max. Negotiated Rate	$7,516.82
Rate for Payer: AlohaCare Medicaid	$7,516.82
Rate for Payer: Hawaii Medical Service Association ABD	$7,516.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,516.82
Rate for Payer: Kaiser Permanente Medicaid	$7,516.82
Rate for Payer: Ohana Health Plan Medicaid	$7,516.82
Rate for Payer: UnitedHealthcare Medicaid	$7,516.82

SPINAL PROCEDURES

Facility

$16,749.83

Service Code	APR-DRG 0233
Min. Negotiated Rate	$16,749.83
Max. Negotiated Rate	$16,749.83
Rate for Payer: AlohaCare Medicaid	$16,749.83
Rate for Payer: Hawaii Medical Service Association ABD	$16,749.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16,749.83
Rate for Payer: Kaiser Permanente Medicaid	$16,749.83
Rate for Payer: Ohana Health Plan Medicaid	$16,749.83
Rate for Payer: UnitedHealthcare Medicaid	$16,749.83

SPINAL PROCEDURES

Facility

$29,339.42

Service Code	APR-DRG 0234
Min. Negotiated Rate	$29,339.42
Max. Negotiated Rate	$29,339.42
Rate for Payer: AlohaCare Medicaid	$29,339.42
Rate for Payer: Hawaii Medical Service Association ABD	$29,339.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$29,339.42
Rate for Payer: Kaiser Permanente Medicaid	$29,339.42
Rate for Payer: Ohana Health Plan Medicaid	$29,339.42
Rate for Payer: UnitedHealthcare Medicaid	$29,339.42

SPINAL PROCEDURES

Facility

$9,721.43

Service Code	APR-DRG 0232
Min. Negotiated Rate	$9,721.43
Max. Negotiated Rate	$9,721.43
Rate for Payer: AlohaCare Medicaid	$9,721.43
Rate for Payer: Hawaii Medical Service Association ABD	$9,721.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,721.43
Rate for Payer: Kaiser Permanente Medicaid	$9,721.43
Rate for Payer: Ohana Health Plan Medicaid	$9,721.43
Rate for Payer: UnitedHealthcare Medicaid	$9,721.43

SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS

Facility

$72,393.32

Service Code	MSDRG 029
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$72,393.32
Rate for Payer: AlohaCare Medicare	$44,871.99
Rate for Payer: Devoted Health Medicare	$49,359.19
Rate for Payer: Hawaii Medical Service Association Commercial	$72,393.32
Rate for Payer: Hawaii Medical Service Association Medicare	$44,871.99
Rate for Payer: Humana Medicare	$44,871.99
Rate for Payer: Kaiser Permanente Commercial	$58,850.10
Rate for Payer: Kaiser Permanente Medicare	$44,871.99
Rate for Payer: Ohana Health Plan Medicare	$44,871.99
Rate for Payer: UnitedHealthcare Medicare	$44,871.99
Rate for Payer: University Health Alliance Commercial	$10,400.00

SPINAL PROCEDURES WITH MCC

Facility

$103,643.18

Service Code	MSDRG 028
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$103,643.18
Rate for Payer: AlohaCare Medicare	$79,025.76
Rate for Payer: Devoted Health Medicare	$86,928.34
Rate for Payer: Hawaii Medical Service Association Commercial	$87,508.41
Rate for Payer: Hawaii Medical Service Association Medicare	$79,025.76
Rate for Payer: Humana Medicare	$79,025.76
Rate for Payer: Kaiser Permanente Commercial	$103,643.18
Rate for Payer: Kaiser Permanente Medicare	$79,025.76
Rate for Payer: Ohana Health Plan Medicare	$79,025.76
Rate for Payer: UnitedHealthcare Medicare	$79,025.76
Rate for Payer: University Health Alliance Commercial	$10,400.00

SPINAL PROCEDURES WITHOUT CC/MCC

Facility

$47,997.04

Service Code	MSDRG 030
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$47,997.04
Rate for Payer: AlohaCare Medicare	$28,872.94
Rate for Payer: Devoted Health Medicare	$31,760.23
Rate for Payer: Hawaii Medical Service Association Commercial	$47,997.04
Rate for Payer: Hawaii Medical Service Association Medicare	$28,872.94
Rate for Payer: Humana Medicare	$28,872.94
Rate for Payer: Kaiser Permanente Commercial	$37,867.20
Rate for Payer: Kaiser Permanente Medicare	$28,872.94
Rate for Payer: Ohana Health Plan Medicare	$28,872.94
Rate for Payer: UnitedHealthcare Medicare	$28,872.94
Rate for Payer: University Health Alliance Commercial	$10,400.00

SPIRONOLACTONE 100 MG PO TABLET

Facility

$7.87

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$7.63
Rate for Payer: Cash Price	$5.12
Rate for Payer: Cash Price	$3.82
Rate for Payer: Hawaii Western Management Group Commercial	$5.59
Rate for Payer: Hawaii Western Management Group Commercial	$7.48
Rate for Payer: Health Management Network Commercial	$5.00
Rate for Payer: Health Management Network Commercial	$6.69
Rate for Payer: Kaiser Permanente Commercial	$3.70
Rate for Payer: Kaiser Permanente Commercial	$4.96
Rate for Payer: Kaiser Permanente Medicaid	$4.01
Rate for Payer: Kaiser Permanente Medicaid	$3.00
Rate for Payer: MDX Hawaii PPO	$5.70
Rate for Payer: MDX Hawaii PPO	$7.63
Rate for Payer: UnitedHealthcare Medicaid	$3.53
Rate for Payer: UnitedHealthcare Medicaid	$4.72
Rate for Payer: University Health Alliance Commercial	$4.29
Rate for Payer: University Health Alliance Commercial	$5.74

SPIRONOLACTONE 100 MG PO TABLET

Facility

$5.88

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$5.70
Rate for Payer: Cash Price	$3.82
Rate for Payer: Cash Price	$5.12
Rate for Payer: Health Management Network Commercial	$5.00
Rate for Payer: Health Management Network Commercial	$6.69
Rate for Payer: MDX Hawaii PPO	$7.63
Rate for Payer: MDX Hawaii PPO	$5.70

SPIRONOLACTONE 25 MG PO TAB (0.5 TAB) = 12.5 MG

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87

SPIRONOLACTONE 25 MG PO TAB (0.5 TAB) = 12.5 MG

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: MDX Hawaii PPO	$1.16

SPIRONOLACTONE 25 MG PO TABLET

Facility

$1.26

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$1.22
Rate for Payer: Cash Price	$0.82
Rate for Payer: Health Management Network Commercial	$1.07
Rate for Payer: MDX Hawaii PPO	$1.22

SPIRONOLACTONE 25 MG PO TABLET

Facility

$1.26

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$1.22
Rate for Payer: Cash Price	$0.82
Rate for Payer: Hawaii Western Management Group Commercial	$1.20
Rate for Payer: Health Management Network Commercial	$1.07
Rate for Payer: Kaiser Permanente Commercial	$0.79
Rate for Payer: Kaiser Permanente Medicaid	$0.64
Rate for Payer: MDX Hawaii PPO	$1.22
Rate for Payer: UnitedHealthcare Medicaid	$0.76
Rate for Payer: University Health Alliance Commercial	$0.92

Know your out-of-pocket cost for care.

All Charges