Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$7,335.97

Service Code	APR-DRG 5122
Min. Negotiated Rate	$7,335.97
Max. Negotiated Rate	$7,335.97
Rate for Payer: AlohaCare Medicaid	$7,335.97
Rate for Payer: Hawaii Medical Service Association ABD	$7,335.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,335.97
Rate for Payer: Kaiser Permanente Medicaid	$7,335.97
Rate for Payer: Ohana Health Plan Medicaid	$7,335.97
Rate for Payer: UnitedHealthcare Medicaid	$7,335.97

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

Facility

$19,945.31

Service Code	APR-DRG 5124
Min. Negotiated Rate	$19,945.31
Max. Negotiated Rate	$19,945.31
Rate for Payer: AlohaCare Medicaid	$19,945.31
Rate for Payer: Hawaii Medical Service Association ABD	$19,945.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19,945.31
Rate for Payer: Kaiser Permanente Medicaid	$19,945.31
Rate for Payer: Ohana Health Plan Medicaid	$19,945.31
Rate for Payer: UnitedHealthcare Medicaid	$19,945.31

UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY

Facility

$24,526.47

Service Code	APR-DRG 5114
Min. Negotiated Rate	$24,526.47
Max. Negotiated Rate	$24,526.47
Rate for Payer: AlohaCare Medicaid	$24,526.47
Rate for Payer: Hawaii Medical Service Association ABD	$24,526.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24,526.47
Rate for Payer: Kaiser Permanente Medicaid	$24,526.47
Rate for Payer: Ohana Health Plan Medicaid	$24,526.47
Rate for Payer: UnitedHealthcare Medicaid	$24,526.47

UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY

Facility

$12,659.01

Service Code	APR-DRG 5113
Min. Negotiated Rate	$12,659.01
Max. Negotiated Rate	$12,659.01
Rate for Payer: AlohaCare Medicaid	$12,659.01
Rate for Payer: Hawaii Medical Service Association ABD	$12,659.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,659.01
Rate for Payer: Kaiser Permanente Medicaid	$12,659.01
Rate for Payer: Ohana Health Plan Medicaid	$12,659.01
Rate for Payer: UnitedHealthcare Medicaid	$12,659.01

UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY

Facility

$8,517.88

Service Code	APR-DRG 5112
Min. Negotiated Rate	$8,517.88
Max. Negotiated Rate	$8,517.88
Rate for Payer: AlohaCare Medicaid	$8,517.88
Rate for Payer: Hawaii Medical Service Association ABD	$8,517.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,517.88
Rate for Payer: Kaiser Permanente Medicaid	$8,517.88
Rate for Payer: Ohana Health Plan Medicaid	$8,517.88
Rate for Payer: UnitedHealthcare Medicaid	$8,517.88

UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY

Facility

$7,025.85

Service Code	APR-DRG 5111
Min. Negotiated Rate	$7,025.85
Max. Negotiated Rate	$7,025.85
Rate for Payer: AlohaCare Medicaid	$7,025.85
Rate for Payer: Hawaii Medical Service Association ABD	$7,025.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,025.85
Rate for Payer: Kaiser Permanente Medicaid	$7,025.85
Rate for Payer: Ohana Health Plan Medicaid	$7,025.85
Rate for Payer: UnitedHealthcare Medicaid	$7,025.85

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC

Facility

$31,650.30

Service Code	MSDRG 742
Min. Negotiated Rate	$22,660.58
Max. Negotiated Rate	$31,650.30
Rate for Payer: AlohaCare Medicare	$24,132.69
Rate for Payer: Devoted Health Medicare	$26,545.96
Rate for Payer: Hawaii Medical Service Association Commercial	$22,660.58
Rate for Payer: Hawaii Medical Service Association Medicare	$24,132.69
Rate for Payer: Humana Medicare	$24,132.69
Rate for Payer: Kaiser Permanente Commercial	$31,650.30
Rate for Payer: Kaiser Permanente Medicare	$24,132.69
Rate for Payer: Ohana Health Plan Medicare	$24,132.69
Rate for Payer: UnitedHealthcare Medicare	$24,132.69

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC

Facility

$21,402.08

Service Code	MSDRG 743
Min. Negotiated Rate	$16,318.64
Max. Negotiated Rate	$21,402.08
Rate for Payer: AlohaCare Medicare	$16,318.64
Rate for Payer: Devoted Health Medicare	$17,950.50
Rate for Payer: Hawaii Medical Service Association Commercial	$20,370.42
Rate for Payer: Hawaii Medical Service Association Medicare	$16,318.64
Rate for Payer: Humana Medicare	$16,318.64
Rate for Payer: Kaiser Permanente Commercial	$21,402.08
Rate for Payer: Kaiser Permanente Medicare	$16,318.64
Rate for Payer: Ohana Health Plan Medicare	$16,318.64
Rate for Payer: UnitedHealthcare Medicare	$16,318.64

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC

Facility

$36,690.85

Service Code	MSDRG 740
Min. Negotiated Rate	$23,801.25
Max. Negotiated Rate	$36,690.85
Rate for Payer: AlohaCare Medicare	$23,801.25
Rate for Payer: Devoted Health Medicare	$26,181.38
Rate for Payer: Hawaii Medical Service Association Commercial	$36,690.85
Rate for Payer: Hawaii Medical Service Association Medicare	$23,801.25
Rate for Payer: Humana Medicare	$23,801.25
Rate for Payer: Kaiser Permanente Commercial	$31,215.60
Rate for Payer: Kaiser Permanente Medicare	$23,801.25
Rate for Payer: Ohana Health Plan Medicare	$23,801.25
Rate for Payer: UnitedHealthcare Medicare	$23,801.25

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC

Facility

$60,828.68

Service Code	MSDRG 739
Min. Negotiated Rate	$38,137.27
Max. Negotiated Rate	$60,828.68
Rate for Payer: AlohaCare Medicare	$47,123.72
Rate for Payer: Devoted Health Medicare	$51,836.09
Rate for Payer: Hawaii Medical Service Association Commercial	$38,137.27
Rate for Payer: Hawaii Medical Service Association Medicare	$47,123.72
Rate for Payer: Humana Medicare	$47,123.72
Rate for Payer: Kaiser Permanente Commercial	$60,828.68
Rate for Payer: Kaiser Permanente Medicare	$47,123.72
Rate for Payer: Ohana Health Plan Medicare	$47,123.72
Rate for Payer: UnitedHealthcare Medicare	$47,123.72

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$26,276.63

Service Code	MSDRG 741
Min. Negotiated Rate	$18,757.16
Max. Negotiated Rate	$26,276.63
Rate for Payer: AlohaCare Medicare	$18,757.16
Rate for Payer: Devoted Health Medicare	$20,632.88
Rate for Payer: Hawaii Medical Service Association Commercial	$26,276.63
Rate for Payer: Hawaii Medical Service Association Medicare	$18,757.16
Rate for Payer: Humana Medicare	$18,757.16
Rate for Payer: Kaiser Permanente Commercial	$24,600.22
Rate for Payer: Kaiser Permanente Medicare	$18,757.16
Rate for Payer: Ohana Health Plan Medicare	$18,757.16
Rate for Payer: UnitedHealthcare Medicare	$18,757.16

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC

Facility

$46,405.97

Service Code	MSDRG 737
Min. Negotiated Rate	$27,102.60
Max. Negotiated Rate	$46,405.97
Rate for Payer: AlohaCare Medicare	$27,102.60
Rate for Payer: Devoted Health Medicare	$29,812.86
Rate for Payer: Hawaii Medical Service Association Commercial	$46,405.97
Rate for Payer: Hawaii Medical Service Association Medicare	$27,102.60
Rate for Payer: Humana Medicare	$27,102.60
Rate for Payer: Kaiser Permanente Commercial	$35,545.35
Rate for Payer: Kaiser Permanente Medicare	$27,102.60
Rate for Payer: Ohana Health Plan Medicare	$27,102.60
Rate for Payer: UnitedHealthcare Medicare	$27,102.60

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC

Facility

$61,660.12

Service Code	MSDRG 736
Min. Negotiated Rate	$46,405.97
Max. Negotiated Rate	$61,660.12
Rate for Payer: AlohaCare Medicare	$47,014.58
Rate for Payer: Devoted Health Medicare	$51,716.04
Rate for Payer: Hawaii Medical Service Association Commercial	$46,405.97
Rate for Payer: Hawaii Medical Service Association Medicare	$47,014.58
Rate for Payer: Humana Medicare	$47,014.58
Rate for Payer: Kaiser Permanente Commercial	$61,660.12
Rate for Payer: Kaiser Permanente Medicare	$47,014.58
Rate for Payer: Ohana Health Plan Medicare	$47,014.58
Rate for Payer: UnitedHealthcare Medicare	$47,014.58

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$46,405.97

Service Code	MSDRG 738
Min. Negotiated Rate	$19,314.84
Max. Negotiated Rate	$46,405.97
Rate for Payer: AlohaCare Medicare	$19,314.84
Rate for Payer: Devoted Health Medicare	$21,246.32
Rate for Payer: Hawaii Medical Service Association Commercial	$46,405.97
Rate for Payer: Hawaii Medical Service Association Medicare	$19,314.84
Rate for Payer: Humana Medicare	$19,314.84
Rate for Payer: Kaiser Permanente Commercial	$25,331.62
Rate for Payer: Kaiser Permanente Medicare	$19,314.84
Rate for Payer: Ohana Health Plan Medicare	$19,314.84
Rate for Payer: UnitedHealthcare Medicare	$19,314.84

Uterine Manipulator Injector Zumi 4.5 ZSI1151 [3608604]

Facility

$444.18

Hospital Charge Code	3608604
Hospital Revenue Code	272
Min. Negotiated Rate	$377.55
Max. Negotiated Rate	$430.85
Rate for Payer: Cash Price	$288.72
Rate for Payer: Health Management Network Commercial	$377.55
Rate for Payer: MDX Hawaii PPO	$430.85

Uterine Manipulator Injector Zumi 4.5 ZSI1151 [3608604]

Facility

$444.18

Hospital Charge Code	3608604
Hospital Revenue Code	272
Min. Negotiated Rate	$226.53
Max. Negotiated Rate	$430.85
Rate for Payer: Cash Price	$288.72
Rate for Payer: Hawaii Western Management Group Commercial	$421.97
Rate for Payer: Health Management Network Commercial	$377.55
Rate for Payer: Kaiser Permanente Commercial	$279.83
Rate for Payer: Kaiser Permanente Medicaid	$226.53
Rate for Payer: MDX Hawaii PPO	$430.85
Rate for Payer: University Health Alliance Commercial	$323.76

Uterine Manipulator RUMI Sleeve 2.5cm KCRUMI25 [3625433]

Facility

$878.95

Hospital Charge Code	3625433
Hospital Revenue Code	272
Min. Negotiated Rate	$747.11
Max. Negotiated Rate	$852.58
Rate for Payer: Cash Price	$571.32
Rate for Payer: Health Management Network Commercial	$747.11
Rate for Payer: MDX Hawaii PPO	$852.58

Uterine Manipulator RUMI Sleeve 2.5cm KCRUMI25 [3625433]

Facility

$878.95

Hospital Charge Code	3625433
Hospital Revenue Code	272
Min. Negotiated Rate	$448.26
Max. Negotiated Rate	$852.58
Rate for Payer: Cash Price	$571.32
Rate for Payer: Hawaii Western Management Group Commercial	$835.00
Rate for Payer: Health Management Network Commercial	$747.11
Rate for Payer: Kaiser Permanente Commercial	$553.74
Rate for Payer: Kaiser Permanente Medicaid	$448.26
Rate for Payer: MDX Hawaii PPO	$852.58
Rate for Payer: University Health Alliance Commercial	$640.67

Uterine Manipulator RUMI Sleeve 3.0cm KCRUMI30 [3625436]

Facility

$878.95

Hospital Charge Code	3625436
Hospital Revenue Code	272
Min. Negotiated Rate	$448.26
Max. Negotiated Rate	$852.58
Rate for Payer: Cash Price	$571.32
Rate for Payer: Hawaii Western Management Group Commercial	$835.00
Rate for Payer: Health Management Network Commercial	$747.11
Rate for Payer: Kaiser Permanente Commercial	$553.74
Rate for Payer: Kaiser Permanente Medicaid	$448.26
Rate for Payer: MDX Hawaii PPO	$852.58
Rate for Payer: University Health Alliance Commercial	$640.67

Uterine Manipulator RUMI Sleeve 3.0cm KCRUMI30 [3625436]

Facility

$878.95

Hospital Charge Code	3625436
Hospital Revenue Code	272
Min. Negotiated Rate	$747.11
Max. Negotiated Rate	$852.58
Rate for Payer: Cash Price	$571.32
Rate for Payer: Health Management Network Commercial	$747.11
Rate for Payer: MDX Hawaii PPO	$852.58

Uterine Manipulator RUMI Sleeve 3.5cm KCRUMI35 [3640738]

Facility

$878.95

Hospital Charge Code	3640738
Hospital Revenue Code	272
Min. Negotiated Rate	$747.11
Max. Negotiated Rate	$852.58
Rate for Payer: Cash Price	$571.32
Rate for Payer: Health Management Network Commercial	$747.11
Rate for Payer: MDX Hawaii PPO	$852.58

Uterine Manipulator RUMI Sleeve 3.5cm KCRUMI35 [3640738]

Facility

$878.95

Hospital Charge Code	3640738
Hospital Revenue Code	272
Min. Negotiated Rate	$448.26
Max. Negotiated Rate	$852.58
Rate for Payer: Cash Price	$571.32
Rate for Payer: Hawaii Western Management Group Commercial	$835.00
Rate for Payer: Health Management Network Commercial	$747.11
Rate for Payer: Kaiser Permanente Commercial	$553.74
Rate for Payer: Kaiser Permanente Medicaid	$448.26
Rate for Payer: MDX Hawaii PPO	$852.58
Rate for Payer: University Health Alliance Commercial	$640.67

Uterine Manipulator RUMI Tip 6.7mm X 10cm UMG670 [3640360]

Facility

$502.20

Hospital Charge Code	3640360
Hospital Revenue Code	272
Min. Negotiated Rate	$256.12
Max. Negotiated Rate	$487.13
Rate for Payer: Cash Price	$326.43
Rate for Payer: Hawaii Western Management Group Commercial	$477.09
Rate for Payer: Health Management Network Commercial	$426.87
Rate for Payer: Kaiser Permanente Commercial	$316.39
Rate for Payer: Kaiser Permanente Medicaid	$256.12
Rate for Payer: MDX Hawaii PPO	$487.13
Rate for Payer: University Health Alliance Commercial	$366.05

Uterine Manipulator RUMI Tip 6.7mm X 10cm UMG670 [3640360]

Facility

$502.20

Hospital Charge Code	3640360
Hospital Revenue Code	272
Min. Negotiated Rate	$426.87
Max. Negotiated Rate	$487.13
Rate for Payer: Cash Price	$326.43
Rate for Payer: Health Management Network Commercial	$426.87
Rate for Payer: MDX Hawaii PPO	$487.13

Uterine Manipulator RUMI Tip 6.7mm X 6cm UMW676 [3640531]

Facility

$445.96

Hospital Charge Code	3640531
Hospital Revenue Code	272
Min. Negotiated Rate	$227.44
Max. Negotiated Rate	$432.58
Rate for Payer: Cash Price	$289.87
Rate for Payer: Hawaii Western Management Group Commercial	$423.66
Rate for Payer: Health Management Network Commercial	$379.07
Rate for Payer: Kaiser Permanente Commercial	$280.95
Rate for Payer: Kaiser Permanente Medicaid	$227.44
Rate for Payer: MDX Hawaii PPO	$432.58
Rate for Payer: University Health Alliance Commercial	$325.06

Know your out-of-pocket cost for care.

All Charges