Kona Community Hospital

All Charges

Charge

Type

Setting

Price

UNCOMPLICATED PEPTIC ULCER WITHOUT MCC

Facility

$19,960.60

Service Code	MSDRG 384
Min. Negotiated Rate	$11,242.97
Max. Negotiated Rate	$19,960.60
Rate for Payer: AlohaCare Medicare	$11,242.97
Rate for Payer: Devoted Health Medicare	$12,367.27
Rate for Payer: Hawaii Medical Service Association Commercial	$19,960.60
Rate for Payer: Hawaii Medical Service Association Medicare	$11,242.97
Rate for Payer: Humana Medicare	$11,242.97
Rate for Payer: Kaiser Permanente Commercial	$14,745.30
Rate for Payer: Kaiser Permanente Medicare	$11,242.97
Rate for Payer: Ohana Health Plan Medicare	$11,242.97
Rate for Payer: UnitedHealthcare Medicare	$11,242.97

Unite Pin Joint Distractor 2.5mmx100mm MPX25100 [3645513]

Facility

$769.60

Hospital Charge Code	3645513
Hospital Revenue Code	272
Min. Negotiated Rate	$654.16
Max. Negotiated Rate	$746.51
Rate for Payer: Cash Price	$500.24
Rate for Payer: Health Management Network Commercial	$654.16
Rate for Payer: MDX Hawaii PPO	$746.51

Unite Pin Joint Distractor 2.5mmx100mm MPX25100 [3645513]

Facility

$769.60

Hospital Charge Code	3645513
Hospital Revenue Code	272
Min. Negotiated Rate	$392.50
Max. Negotiated Rate	$746.51
Rate for Payer: Cash Price	$500.24
Rate for Payer: Hawaii Western Management Group Commercial	$731.12
Rate for Payer: Health Management Network Commercial	$654.16
Rate for Payer: Kaiser Permanente Commercial	$484.85
Rate for Payer: Kaiser Permanente Medicaid	$392.50
Rate for Payer: MDX Hawaii PPO	$746.51
Rate for Payer: University Health Alliance Commercial	$560.96

Unite Pin Temp Fix Smooth 1.1mmx10mm MPPF1110 [3645512]

Facility

$823.15

Hospital Charge Code	3645512
Hospital Revenue Code	272
Min. Negotiated Rate	$419.81
Max. Negotiated Rate	$798.46
Rate for Payer: Cash Price	$535.05
Rate for Payer: Hawaii Western Management Group Commercial	$781.99
Rate for Payer: Health Management Network Commercial	$699.68
Rate for Payer: Kaiser Permanente Commercial	$518.58
Rate for Payer: Kaiser Permanente Medicaid	$419.81
Rate for Payer: MDX Hawaii PPO	$798.46
Rate for Payer: University Health Alliance Commercial	$599.99

Unite Pin Temp Fix Smooth 1.1mmx10mm MPPF1110 [3645512]

Facility

$823.15

Hospital Charge Code	3645512
Hospital Revenue Code	272
Min. Negotiated Rate	$699.68
Max. Negotiated Rate	$798.46
Rate for Payer: Cash Price	$535.05
Rate for Payer: Health Management Network Commercial	$699.68
Rate for Payer: MDX Hawaii PPO	$798.46

Unite Plate Midfoot Fusion Straight 6h MPP0006U [3645504]

Facility

$8,643.00

Service Code	HCPCS C1713
Hospital Charge Code	3645504
Hospital Revenue Code	278
Min. Negotiated Rate	$4,840.08
Max. Negotiated Rate	$8,383.71
Rate for Payer: Cash Price	$5,617.95
Rate for Payer: Hawaii Western Management Group Commercial	$6,050.10
Rate for Payer: Health Management Network Commercial	$7,346.55
Rate for Payer: MDX Hawaii PPO	$8,383.71
Rate for Payer: University Health Alliance Commercial	$4,840.08

Unite Plate Midfoot Fusion Straight 6h MPP0006U [3645504]

Facility

$8,643.00

Service Code	HCPCS C1713
Hospital Charge Code	3645504
Hospital Revenue Code	278
Min. Negotiated Rate	$4,407.93
Max. Negotiated Rate	$8,383.71
Rate for Payer: Cash Price	$5,617.95
Rate for Payer: Hawaii Western Management Group Commercial	$6,050.10
Rate for Payer: Health Management Network Commercial	$7,346.55
Rate for Payer: Kaiser Permanente Commercial	$5,445.09
Rate for Payer: Kaiser Permanente Medicaid	$4,407.93
Rate for Payer: MDX Hawaii PPO	$8,383.71
Rate for Payer: University Health Alliance Commercial	$4,840.08

Unite Screw Non-Lock 2.7mmx16mm MPSN2716 [3645505]

Facility

$1,385.43

Service Code	HCPCS C1713
Hospital Charge Code	3645505
Hospital Revenue Code	278
Min. Negotiated Rate	$706.57
Max. Negotiated Rate	$1,343.87
Rate for Payer: Cash Price	$900.53
Rate for Payer: Hawaii Western Management Group Commercial	$969.80
Rate for Payer: Health Management Network Commercial	$1,177.62
Rate for Payer: Kaiser Permanente Commercial	$872.82
Rate for Payer: Kaiser Permanente Medicaid	$706.57
Rate for Payer: MDX Hawaii PPO	$1,343.87
Rate for Payer: University Health Alliance Commercial	$775.84

Unite Screw Non-Lock 2.7mmx16mm MPSN2716 [3645505]

Facility

$1,385.43

Service Code	HCPCS C1713
Hospital Charge Code	3645505
Hospital Revenue Code	278
Min. Negotiated Rate	$775.84
Max. Negotiated Rate	$1,343.87
Rate for Payer: Cash Price	$900.53
Rate for Payer: Hawaii Western Management Group Commercial	$969.80
Rate for Payer: Health Management Network Commercial	$1,177.62
Rate for Payer: MDX Hawaii PPO	$1,343.87
Rate for Payer: University Health Alliance Commercial	$775.84

Unite Screw Non-Lock 3.5mmx16mm MPSN3516 [3645509]

Facility

$1,385.43

Service Code	HCPCS C1713
Hospital Charge Code	3645509
Hospital Revenue Code	278
Min. Negotiated Rate	$775.84
Max. Negotiated Rate	$1,343.87
Rate for Payer: Cash Price	$900.53
Rate for Payer: Hawaii Western Management Group Commercial	$969.80
Rate for Payer: Health Management Network Commercial	$1,177.62
Rate for Payer: MDX Hawaii PPO	$1,343.87
Rate for Payer: University Health Alliance Commercial	$775.84

Unite Screw Non-Lock 3.5mmx16mm MPSN3516 [3645509]

Facility

$1,385.43

Service Code	HCPCS C1713
Hospital Charge Code	3645509
Hospital Revenue Code	278
Min. Negotiated Rate	$706.57
Max. Negotiated Rate	$1,343.87
Rate for Payer: Cash Price	$900.53
Rate for Payer: Hawaii Western Management Group Commercial	$969.80
Rate for Payer: Health Management Network Commercial	$1,177.62
Rate for Payer: Kaiser Permanente Commercial	$872.82
Rate for Payer: Kaiser Permanente Medicaid	$706.57
Rate for Payer: MDX Hawaii PPO	$1,343.87
Rate for Payer: University Health Alliance Commercial	$775.84

Unite Screw Non-Lock 3.5mmx20mm MPSN3520 [3645510]

Facility

$1,385.43

Service Code	HCPCS C1713
Hospital Charge Code	3645510
Hospital Revenue Code	278
Min. Negotiated Rate	$706.57
Max. Negotiated Rate	$1,343.87
Rate for Payer: Cash Price	$900.53
Rate for Payer: Hawaii Western Management Group Commercial	$969.80
Rate for Payer: Health Management Network Commercial	$1,177.62
Rate for Payer: Kaiser Permanente Commercial	$872.82
Rate for Payer: Kaiser Permanente Medicaid	$706.57
Rate for Payer: MDX Hawaii PPO	$1,343.87
Rate for Payer: University Health Alliance Commercial	$775.84

Unite Screw Non-Lock 3.5mmx20mm MPSN3520 [3645510]

Facility

$1,385.43

Service Code	HCPCS C1713
Hospital Charge Code	3645510
Hospital Revenue Code	278
Min. Negotiated Rate	$775.84
Max. Negotiated Rate	$1,343.87
Rate for Payer: Cash Price	$900.53
Rate for Payer: Hawaii Western Management Group Commercial	$969.80
Rate for Payer: Health Management Network Commercial	$1,177.62
Rate for Payer: MDX Hawaii PPO	$1,343.87
Rate for Payer: University Health Alliance Commercial	$775.84

Unite Screw Polyaxial Lock 2.7x10mm MPSL2710 [3645507]

Facility

$1,804.38

Service Code	HCPCS C1713
Hospital Charge Code	3645507
Hospital Revenue Code	278
Min. Negotiated Rate	$1,010.45
Max. Negotiated Rate	$1,750.25
Rate for Payer: Cash Price	$1,172.85
Rate for Payer: Hawaii Western Management Group Commercial	$1,263.07
Rate for Payer: Health Management Network Commercial	$1,533.72
Rate for Payer: MDX Hawaii PPO	$1,750.25
Rate for Payer: University Health Alliance Commercial	$1,010.45

Unite Screw Polyaxial Lock 2.7x10mm MPSL2710 [3645507]

Facility

$1,804.38

Service Code	HCPCS C1713
Hospital Charge Code	3645507
Hospital Revenue Code	278
Min. Negotiated Rate	$920.23
Max. Negotiated Rate	$1,750.25
Rate for Payer: Cash Price	$1,172.85
Rate for Payer: Hawaii Western Management Group Commercial	$1,263.07
Rate for Payer: Health Management Network Commercial	$1,533.72
Rate for Payer: Kaiser Permanente Commercial	$1,136.76
Rate for Payer: Kaiser Permanente Medicaid	$920.23
Rate for Payer: MDX Hawaii PPO	$1,750.25
Rate for Payer: University Health Alliance Commercial	$1,010.45

Unite Screw Polyaxial Lock 3.5x20mm MPSL3520 [3645511]

Facility

$1,804.38

Service Code	HCPCS C1713
Hospital Charge Code	3645511
Hospital Revenue Code	278
Min. Negotiated Rate	$1,010.45
Max. Negotiated Rate	$1,750.25
Rate for Payer: Cash Price	$1,172.85
Rate for Payer: Hawaii Western Management Group Commercial	$1,263.07
Rate for Payer: Health Management Network Commercial	$1,533.72
Rate for Payer: MDX Hawaii PPO	$1,750.25
Rate for Payer: University Health Alliance Commercial	$1,010.45

Unite Screw Polyaxial Lock 3.5x20mm MPSL3520 [3645511]

Facility

$1,804.38

Service Code	HCPCS C1713
Hospital Charge Code	3645511
Hospital Revenue Code	278
Min. Negotiated Rate	$920.23
Max. Negotiated Rate	$1,750.25
Rate for Payer: Cash Price	$1,172.85
Rate for Payer: Hawaii Western Management Group Commercial	$1,263.07
Rate for Payer: Health Management Network Commercial	$1,533.72
Rate for Payer: Kaiser Permanente Commercial	$1,136.76
Rate for Payer: Kaiser Permanente Medicaid	$920.23
Rate for Payer: MDX Hawaii PPO	$1,750.25
Rate for Payer: University Health Alliance Commercial	$1,010.45

Univers Revers Humeral Stem, Sz11 AR-9501-11P [3645556]

Facility

$16,000.00

Service Code	HCPCS C1776
Hospital Charge Code	3645556
Hospital Revenue Code	278
Min. Negotiated Rate	$8,960.00
Max. Negotiated Rate	$15,520.00
Rate for Payer: Cash Price	$10,400.00
Rate for Payer: Hawaii Western Management Group Commercial	$11,200.00
Rate for Payer: Health Management Network Commercial	$13,600.00
Rate for Payer: MDX Hawaii PPO	$15,520.00
Rate for Payer: University Health Alliance Commercial	$8,960.00

Univers Revers Humeral Stem, Sz11 AR-9501-11P [3645556]

Facility

$16,000.00

Service Code	HCPCS C1776
Hospital Charge Code	3645556
Hospital Revenue Code	278
Min. Negotiated Rate	$8,160.00
Max. Negotiated Rate	$15,520.00
Rate for Payer: Cash Price	$10,400.00
Rate for Payer: Hawaii Western Management Group Commercial	$11,200.00
Rate for Payer: Health Management Network Commercial	$13,600.00
Rate for Payer: Kaiser Permanente Commercial	$10,080.00
Rate for Payer: Kaiser Permanente Medicaid	$8,160.00
Rate for Payer: MDX Hawaii PPO	$15,520.00
Rate for Payer: University Health Alliance Commercial	$8,960.00

UNLISTED LAPAROSCOPIC PROCEDURE, LIVER

Facility

$8,927.31

Service Code	CPT 47379
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$8,927.31
Rate for Payer: AlohaCare Medicaid	$7,141.85
Rate for Payer: AlohaCare Medicare	$7,141.85
Rate for Payer: Devoted Health Medicare	$7,856.03
Rate for Payer: Hawaii Medical Service Association Commercial	$8,927.31
Rate for Payer: Hawaii Medical Service Association Medicare	$7,141.85
Rate for Payer: Humana Medicare	$7,141.85
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$7,141.85
Rate for Payer: Ohana Health Plan Medicaid	$7,856.03
Rate for Payer: Ohana Health Plan Medicare	$7,141.85
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$7,141.85

UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM

Facility

$8,927.31

Service Code	CPT 49329
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$8,927.31
Rate for Payer: AlohaCare Medicaid	$7,141.85
Rate for Payer: AlohaCare Medicare	$7,141.85
Rate for Payer: Devoted Health Medicare	$7,856.03
Rate for Payer: Hawaii Medical Service Association Commercial	$8,927.31
Rate for Payer: Hawaii Medical Service Association Medicare	$7,141.85
Rate for Payer: Humana Medicare	$7,141.85
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$7,141.85
Rate for Payer: Ohana Health Plan Medicaid	$7,856.03
Rate for Payer: Ohana Health Plan Medicare	$7,141.85
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$7,141.85

UNLISTED LAPAROSCOPY PROCEDURE, BILIARY TRACT

Facility

$8,927.31

Service Code	CPT 47579
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$8,927.31
Rate for Payer: AlohaCare Medicaid	$7,141.85
Rate for Payer: AlohaCare Medicare	$7,141.85
Rate for Payer: Devoted Health Medicare	$7,856.03
Rate for Payer: Hawaii Medical Service Association Commercial	$8,927.31
Rate for Payer: Hawaii Medical Service Association Medicare	$7,141.85
Rate for Payer: Humana Medicare	$7,141.85
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$7,141.85
Rate for Payer: Ohana Health Plan Medicaid	$7,856.03
Rate for Payer: Ohana Health Plan Medicare	$7,141.85
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$7,141.85

UNLISTED LAPAROSCOPY PROCEDURE, HERNIOPLASTY, HERNIORRHAPHY, HERNIOTOMY

Facility

$8,927.31

Service Code	CPT 49659
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$8,927.31
Rate for Payer: AlohaCare Medicaid	$7,141.85
Rate for Payer: AlohaCare Medicare	$7,141.85
Rate for Payer: Devoted Health Medicare	$7,856.03
Rate for Payer: Hawaii Medical Service Association Commercial	$8,927.31
Rate for Payer: Hawaii Medical Service Association Medicare	$7,141.85
Rate for Payer: Humana Medicare	$7,141.85
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$7,141.85
Rate for Payer: Ohana Health Plan Medicaid	$7,856.03
Rate for Payer: Ohana Health Plan Medicare	$7,141.85
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$7,141.85

UNLISTED LAPAROSCOPY PROCEDURE, INTESTINE (EXCEPT RECTUM)

Facility

$13,923.44

Service Code	CPT 44238
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$13,923.44
Rate for Payer: AlohaCare Medicaid	$7,141.85
Rate for Payer: AlohaCare Medicare	$7,141.85
Rate for Payer: Devoted Health Medicare	$7,856.03
Rate for Payer: Hawaii Medical Service Association Commercial	$8,927.31
Rate for Payer: Hawaii Medical Service Association Medicare	$7,141.85
Rate for Payer: Humana Medicare	$7,141.85
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$7,141.85
Rate for Payer: Ohana Health Plan Medicaid	$7,856.03
Rate for Payer: Ohana Health Plan Medicare	$7,141.85
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$7,141.85
Rate for Payer: University Health Alliance Commercial	$13,923.44

UNLISTED LAPAROSCOPY PROCEDURE, SPERMATIC CORD

Facility

$8,927.31

Service Code	CPT 55559
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$8,927.31
Rate for Payer: AlohaCare Medicaid	$7,141.85
Rate for Payer: AlohaCare Medicare	$7,141.85
Rate for Payer: Devoted Health Medicare	$7,856.03
Rate for Payer: Hawaii Medical Service Association Commercial	$8,927.31
Rate for Payer: Hawaii Medical Service Association Medicare	$7,141.85
Rate for Payer: Humana Medicare	$7,141.85
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$7,141.85
Rate for Payer: Ohana Health Plan Medicaid	$7,856.03
Rate for Payer: Ohana Health Plan Medicare	$7,141.85
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$7,141.85

Know your out-of-pocket cost for care.

All Charges