Kona Community Hospital

All Charges

Charge

Type

Setting

Price

URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION

Facility

$5,396.27

Service Code	APR-DRG 4653
Min. Negotiated Rate	$5,396.27
Max. Negotiated Rate	$5,396.27
Rate for Payer: AlohaCare Medicaid	$5,396.27
Rate for Payer: Hawaii Medical Service Association ABD	$5,396.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,396.27
Rate for Payer: Kaiser Permanente Medicaid	$5,396.27
Rate for Payer: Ohana Health Plan Medicaid	$5,396.27
Rate for Payer: UnitedHealthcare Medicaid	$5,396.27

URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION

Facility

$2,779.01

Service Code	APR-DRG 4651
Min. Negotiated Rate	$2,779.01
Max. Negotiated Rate	$2,779.01
Rate for Payer: AlohaCare Medicaid	$2,779.01
Rate for Payer: Hawaii Medical Service Association ABD	$2,779.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,779.01
Rate for Payer: Kaiser Permanente Medicaid	$2,779.01
Rate for Payer: Ohana Health Plan Medicaid	$2,779.01
Rate for Payer: UnitedHealthcare Medicaid	$2,779.01

URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION

Facility

$3,350.22

Service Code	APR-DRG 4652
Min. Negotiated Rate	$3,350.22
Max. Negotiated Rate	$3,350.22
Rate for Payer: AlohaCare Medicaid	$3,350.22
Rate for Payer: Hawaii Medical Service Association ABD	$3,350.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,350.22
Rate for Payer: Kaiser Permanente Medicaid	$3,350.22
Rate for Payer: Ohana Health Plan Medicaid	$3,350.22
Rate for Payer: UnitedHealthcare Medicaid	$3,350.22

URINARY STONES WITH MCC

Facility

$23,192.62

Service Code	MSDRG 693
Min. Negotiated Rate	$12,752.60
Max. Negotiated Rate	$23,192.62
Rate for Payer: AlohaCare Medicare	$17,683.89
Rate for Payer: Devoted Health Medicare	$19,452.28
Rate for Payer: Hawaii Medical Service Association Commercial	$12,752.60
Rate for Payer: Hawaii Medical Service Association Medicare	$17,683.89
Rate for Payer: Humana Medicare	$17,683.89
Rate for Payer: Kaiser Permanente Commercial	$23,192.62
Rate for Payer: Kaiser Permanente Medicare	$17,683.89
Rate for Payer: Ohana Health Plan Medicare	$17,683.89
Rate for Payer: UnitedHealthcare Medicare	$17,683.89

URINARY STONES WITHOUT MCC

Facility

$13,484.33

Service Code	MSDRG 694
Min. Negotiated Rate	$10,281.52
Max. Negotiated Rate	$13,484.33
Rate for Payer: AlohaCare Medicare	$10,281.52
Rate for Payer: Devoted Health Medicare	$11,309.67
Rate for Payer: Hawaii Medical Service Association Commercial	$11,908.86
Rate for Payer: Hawaii Medical Service Association Medicare	$10,281.52
Rate for Payer: Humana Medicare	$10,281.52
Rate for Payer: Kaiser Permanente Commercial	$13,484.33
Rate for Payer: Kaiser Permanente Medicare	$10,281.52
Rate for Payer: Ohana Health Plan Medicare	$10,281.52
Rate for Payer: UnitedHealthcare Medicare	$10,281.52

URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS

Professional

Both

$17.00

Service Code	HCPCS 81025
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$14.45
Rate for Payer: AlohaCare Medicaid	$8.74
Rate for Payer: AlohaCare Medicare	$8.61
Rate for Payer: Cash Price	$11.05
Rate for Payer: Cash Price	$11.05
Rate for Payer: Devoted Health Medicare	$9.47
Rate for Payer: Hawaii Medical Service Association Medicare	$8.61
Rate for Payer: Hawaii Western Management Group Commercial	$8.75
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$10.33
Rate for Payer: Kaiser Permanente Medicaid	$10.33
Rate for Payer: Kaiser Permanente Medicare	$10.33
Rate for Payer: Ohana Health Plan Medicaid	$8.74
Rate for Payer: Ohana Health Plan Medicare	$8.61
Rate for Payer: UnitedHealthcare Medicaid	$8.74
Rate for Payer: UnitedHealthcare Medicare	$8.61

URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP

Professional

Both

$7.00

Service Code	HCPCS 81002
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$5.95
Rate for Payer: AlohaCare Medicaid	$3.54
Rate for Payer: AlohaCare Medicare	$3.48
Rate for Payer: Cash Price	$4.55
Rate for Payer: Cash Price	$4.55
Rate for Payer: Devoted Health Medicare	$3.83
Rate for Payer: Hawaii Medical Service Association Medicare	$3.48
Rate for Payer: Hawaii Western Management Group Commercial	$3.55
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$4.18
Rate for Payer: Kaiser Permanente Medicaid	$4.18
Rate for Payer: Kaiser Permanente Medicare	$4.18
Rate for Payer: Ohana Health Plan Medicaid	$3.54
Rate for Payer: Ohana Health Plan Medicare	$3.48
Rate for Payer: UnitedHealthcare Medicaid	$3.54
Rate for Payer: UnitedHealthcare Medicare	$3.48

Uro Disposal Reservoir CMS515 [3600877]

Facility

$215.51

Hospital Charge Code	3600877
Hospital Revenue Code	272
Min. Negotiated Rate	$109.91
Max. Negotiated Rate	$209.04
Rate for Payer: Cash Price	$140.08
Rate for Payer: Hawaii Western Management Group Commercial	$204.73
Rate for Payer: Health Management Network Commercial	$183.18
Rate for Payer: Kaiser Permanente Commercial	$135.77
Rate for Payer: Kaiser Permanente Medicaid	$109.91
Rate for Payer: MDX Hawaii PPO	$209.04
Rate for Payer: University Health Alliance Commercial	$157.09

Uro Disposal Reservoir CMS515 [3600877]

Facility

$215.51

Hospital Charge Code	3600877
Hospital Revenue Code	272
Min. Negotiated Rate	$183.18
Max. Negotiated Rate	$209.04
Rate for Payer: Cash Price	$140.08
Rate for Payer: Health Management Network Commercial	$183.18
Rate for Payer: MDX Hawaii PPO	$209.04

URSODIOL 300 MG PO CAP

Facility

$45.15

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$38.38
Max. Negotiated Rate	$43.80
Rate for Payer: Cash Price	$29.35
Rate for Payer: Health Management Network Commercial	$38.38
Rate for Payer: MDX Hawaii PPO	$43.80

URSODIOL 300 MG PO CAP

Facility

$45.15

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$23.03
Max. Negotiated Rate	$43.80
Rate for Payer: Cash Price	$29.35
Rate for Payer: Hawaii Western Management Group Commercial	$42.89
Rate for Payer: Health Management Network Commercial	$38.38
Rate for Payer: Kaiser Permanente Commercial	$28.44
Rate for Payer: Kaiser Permanente Medicaid	$23.03
Rate for Payer: MDX Hawaii PPO	$43.80
Rate for Payer: UnitedHealthcare Medicaid	$27.09
Rate for Payer: University Health Alliance Commercial	$32.91

USTEKINUMAB 130 MG/26 ML IV SOLN

Facility

$3,661.98

Service Code	HCPCS J3358
Hospital Revenue Code	250
Min. Negotiated Rate	$3,112.68
Max. Negotiated Rate	$3,552.12
Rate for Payer: Cash Price	$2,380.29
Rate for Payer: Health Management Network Commercial	$3,112.68
Rate for Payer: MDX Hawaii PPO	$3,552.12

USTEKINUMAB 130 MG/26 ML IV SOLN

Facility

$3,661.98

Service Code	HCPCS J3358
Hospital Revenue Code	636
Min. Negotiated Rate	$11.62
Max. Negotiated Rate	$3,552.12
Rate for Payer: AlohaCare Medicaid	$11.62
Rate for Payer: AlohaCare Medicare	$11.62
Rate for Payer: Cash Price	$2,380.29
Rate for Payer: Cash Price	$2,380.29
Rate for Payer: Devoted Health Medicare	$12.78
Rate for Payer: Hawaii Medical Service Association ABD	$13.29
Rate for Payer: Hawaii Medical Service Association Commercial	$14.53
Rate for Payer: Hawaii Medical Service Association Medicare	$11.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.29
Rate for Payer: Hawaii Western Management Group Commercial	$3,478.88
Rate for Payer: Health Management Network Commercial	$3,112.68
Rate for Payer: Humana Medicare	$11.62
Rate for Payer: Kaiser Permanente Commercial	$2,307.05
Rate for Payer: Kaiser Permanente Medicaid	$1,867.61
Rate for Payer: Kaiser Permanente Medicare	$11.62
Rate for Payer: MDX Hawaii PPO	$3,552.12
Rate for Payer: Ohana Health Plan Medicaid	$12.78
Rate for Payer: Ohana Health Plan Medicare	$11.62
Rate for Payer: UnitedHealthcare Medicaid	$2,197.19
Rate for Payer: UnitedHealthcare Medicare	$11.62
Rate for Payer: University Health Alliance Commercial	$2,669.22

USTEKINUMAB-KFCE 130 MG/26 ML IV SOLN

Facility

$1,070.37

Service Code	HCPCS Q5100
Hospital Revenue Code	250
Min. Negotiated Rate	$909.81
Max. Negotiated Rate	$1,038.26
Rate for Payer: Cash Price	$695.74
Rate for Payer: Health Management Network Commercial	$909.81
Rate for Payer: MDX Hawaii PPO	$1,038.26

USTEKINUMAB-KFCE 130 MG/26 ML IV SOLN

Facility

$1,070.37

Service Code	HCPCS Q5100
Hospital Revenue Code	250
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$1,038.26
Rate for Payer: AlohaCare Medicaid	$3.35
Rate for Payer: AlohaCare Medicare	$3.35
Rate for Payer: Cash Price	$695.74
Rate for Payer: Cash Price	$695.74
Rate for Payer: Devoted Health Medicare	$3.69
Rate for Payer: Hawaii Medical Service Association Commercial	$4.19
Rate for Payer: Hawaii Medical Service Association Medicare	$3.35
Rate for Payer: Hawaii Western Management Group Commercial	$1,016.85
Rate for Payer: Health Management Network Commercial	$909.81
Rate for Payer: Humana Medicare	$3.35
Rate for Payer: Kaiser Permanente Commercial	$674.33
Rate for Payer: Kaiser Permanente Medicaid	$545.89
Rate for Payer: Kaiser Permanente Medicare	$3.35
Rate for Payer: MDX Hawaii PPO	$1,038.26
Rate for Payer: Ohana Health Plan Medicaid	$3.69
Rate for Payer: Ohana Health Plan Medicare	$3.35
Rate for Payer: UnitedHealthcare Medicaid	$642.22
Rate for Payer: UnitedHealthcare Medicare	$3.35
Rate for Payer: University Health Alliance Commercial	$780.19

UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$4,689.42

Service Code	APR-DRG 5191
Min. Negotiated Rate	$4,689.42
Max. Negotiated Rate	$4,689.42
Rate for Payer: AlohaCare Medicaid	$4,689.42
Rate for Payer: Hawaii Medical Service Association ABD	$4,689.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,689.42
Rate for Payer: Kaiser Permanente Medicaid	$4,689.42
Rate for Payer: Ohana Health Plan Medicaid	$4,689.42
Rate for Payer: UnitedHealthcare Medicaid	$4,689.42

UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$9,831.60

Service Code	APR-DRG 5193
Min. Negotiated Rate	$9,831.60
Max. Negotiated Rate	$9,831.60
Rate for Payer: AlohaCare Medicaid	$9,831.60
Rate for Payer: Hawaii Medical Service Association ABD	$9,831.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,831.60
Rate for Payer: Kaiser Permanente Medicaid	$9,831.60
Rate for Payer: Ohana Health Plan Medicaid	$9,831.60
Rate for Payer: UnitedHealthcare Medicaid	$9,831.60

UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$5,934.37

Service Code	APR-DRG 5192
Min. Negotiated Rate	$5,934.37
Max. Negotiated Rate	$5,934.37
Rate for Payer: AlohaCare Medicaid	$5,934.37
Rate for Payer: Hawaii Medical Service Association ABD	$5,934.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,934.37
Rate for Payer: Kaiser Permanente Medicaid	$5,934.37
Rate for Payer: Ohana Health Plan Medicaid	$5,934.37
Rate for Payer: UnitedHealthcare Medicaid	$5,934.37

UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$18,600.38

Service Code	APR-DRG 5194
Min. Negotiated Rate	$18,600.38
Max. Negotiated Rate	$18,600.38
Rate for Payer: AlohaCare Medicaid	$18,600.38
Rate for Payer: Hawaii Medical Service Association ABD	$18,600.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18,600.38
Rate for Payer: Kaiser Permanente Medicaid	$18,600.38
Rate for Payer: Ohana Health Plan Medicaid	$18,600.38
Rate for Payer: UnitedHealthcare Medicaid	$18,600.38

UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$4,932.04

Service Code	APR-DRG 5131
Min. Negotiated Rate	$4,932.04
Max. Negotiated Rate	$4,932.04
Rate for Payer: AlohaCare Medicaid	$4,932.04
Rate for Payer: Hawaii Medical Service Association ABD	$4,932.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,932.04
Rate for Payer: Kaiser Permanente Medicaid	$4,932.04
Rate for Payer: Ohana Health Plan Medicaid	$4,932.04
Rate for Payer: UnitedHealthcare Medicaid	$4,932.04

UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$9,147.68

Service Code	APR-DRG 5133
Min. Negotiated Rate	$9,147.68
Max. Negotiated Rate	$9,147.68
Rate for Payer: AlohaCare Medicaid	$9,147.68
Rate for Payer: Hawaii Medical Service Association ABD	$9,147.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,147.68
Rate for Payer: Kaiser Permanente Medicaid	$9,147.68
Rate for Payer: Ohana Health Plan Medicaid	$9,147.68
Rate for Payer: UnitedHealthcare Medicaid	$9,147.68

UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$5,999.32

Service Code	APR-DRG 5132
Min. Negotiated Rate	$5,999.32
Max. Negotiated Rate	$5,999.32
Rate for Payer: AlohaCare Medicaid	$5,999.32
Rate for Payer: Hawaii Medical Service Association ABD	$5,999.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,999.32
Rate for Payer: Kaiser Permanente Medicaid	$5,999.32
Rate for Payer: Ohana Health Plan Medicaid	$5,999.32
Rate for Payer: UnitedHealthcare Medicaid	$5,999.32

UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$16,839.62

Service Code	APR-DRG 5134
Min. Negotiated Rate	$16,839.62
Max. Negotiated Rate	$16,839.62
Rate for Payer: AlohaCare Medicaid	$16,839.62
Rate for Payer: Hawaii Medical Service Association ABD	$16,839.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16,839.62
Rate for Payer: Kaiser Permanente Medicaid	$16,839.62
Rate for Payer: Ohana Health Plan Medicaid	$16,839.62
Rate for Payer: UnitedHealthcare Medicaid	$16,839.62

UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG

Facility

$11,269.50

Service Code	APR-DRG 5123
Min. Negotiated Rate	$11,269.50
Max. Negotiated Rate	$11,269.50
Rate for Payer: AlohaCare Medicaid	$11,269.50
Rate for Payer: Hawaii Medical Service Association ABD	$11,269.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,269.50
Rate for Payer: Kaiser Permanente Medicaid	$11,269.50
Rate for Payer: Ohana Health Plan Medicaid	$11,269.50
Rate for Payer: UnitedHealthcare Medicaid	$11,269.50

UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG

Facility

$6,143.24

Service Code	APR-DRG 5121
Min. Negotiated Rate	$6,143.24
Max. Negotiated Rate	$6,143.24
Rate for Payer: AlohaCare Medicaid	$6,143.24
Rate for Payer: Hawaii Medical Service Association ABD	$6,143.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,143.24
Rate for Payer: Kaiser Permanente Medicaid	$6,143.24
Rate for Payer: Ohana Health Plan Medicaid	$6,143.24
Rate for Payer: UnitedHealthcare Medicaid	$6,143.24

Know your out-of-pocket cost for care.

All Charges