Kona Community Hospital

All Charges

Charge

Type

Setting

Price

CELLULITIS & OTHER SKIN INFECTIONS

Facility

$3,059.20

Service Code	APR-DRG 3832
Min. Negotiated Rate	$3,059.20
Max. Negotiated Rate	$3,059.20
Rate for Payer: AlohaCare Medicaid	$3,059.20
Rate for Payer: Hawaii Medical Service Association ABD	$3,059.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,059.20
Rate for Payer: Kaiser Permanente Medicaid	$3,059.20
Rate for Payer: Ohana Health Plan Medicaid	$3,059.20
Rate for Payer: UnitedHealthcare Medicaid	$3,059.20

CELLULITIS & OTHER SKIN INFECTIONS

Facility

$2,246.00

Service Code	APR-DRG 3831
Min. Negotiated Rate	$2,246.00
Max. Negotiated Rate	$2,246.00
Rate for Payer: AlohaCare Medicaid	$2,246.00
Rate for Payer: Hawaii Medical Service Association ABD	$2,246.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,246.00
Rate for Payer: Kaiser Permanente Medicaid	$2,246.00
Rate for Payer: Ohana Health Plan Medicaid	$2,246.00
Rate for Payer: UnitedHealthcare Medicaid	$2,246.00

CELLULITIS & OTHER SKIN INFECTIONS

Facility

$4,495.19

Service Code	APR-DRG 3833
Min. Negotiated Rate	$4,495.19
Max. Negotiated Rate	$4,495.19
Rate for Payer: AlohaCare Medicaid	$4,495.19
Rate for Payer: Hawaii Medical Service Association ABD	$4,495.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,495.19
Rate for Payer: Kaiser Permanente Medicaid	$4,495.19
Rate for Payer: Ohana Health Plan Medicaid	$4,495.19
Rate for Payer: UnitedHealthcare Medicaid	$4,495.19

CELLULITIS WITH MCC

Facility

$24,517.42

Service Code	MSDRG 602
Min. Negotiated Rate	$18,694.02
Max. Negotiated Rate	$24,517.42
Rate for Payer: AlohaCare Medicare	$18,694.02
Rate for Payer: Devoted Health Medicare	$20,563.42
Rate for Payer: Hawaii Medical Service Association Commercial	$24,396.28
Rate for Payer: Hawaii Medical Service Association Medicare	$18,694.02
Rate for Payer: Humana Medicare	$18,694.02
Rate for Payer: Kaiser Permanente Commercial	$24,517.42
Rate for Payer: Kaiser Permanente Medicare	$18,694.02
Rate for Payer: Ohana Health Plan Medicare	$18,694.02
Rate for Payer: UnitedHealthcare Medicare	$18,694.02

CELLULITIS WITHOUT MCC

Facility

$16,416.87

Service Code	MSDRG 603
Min. Negotiated Rate	$11,454.75
Max. Negotiated Rate	$16,416.87
Rate for Payer: AlohaCare Medicare	$11,454.75
Rate for Payer: Devoted Health Medicare	$12,600.23
Rate for Payer: Hawaii Medical Service Association Commercial	$16,416.87
Rate for Payer: Hawaii Medical Service Association Medicare	$11,454.75
Rate for Payer: Humana Medicare	$11,454.75
Rate for Payer: Kaiser Permanente Commercial	$15,023.02
Rate for Payer: Kaiser Permanente Medicare	$11,454.75
Rate for Payer: Ohana Health Plan Medicare	$11,454.75
Rate for Payer: UnitedHealthcare Medicare	$11,454.75

Cement Bone Cobalt Hv 40gm 600-15-000 [3644485]

Facility

$1,727.50

Service Code	HCPCS C1889
Hospital Charge Code	3644485
Hospital Revenue Code	278
Min. Negotiated Rate	$967.40
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Cement Bone Cobalt Hv 40gm 600-15-000 [3644485]

Facility

$1,727.50

Service Code	HCPCS C1889
Hospital Charge Code	3644485
Hospital Revenue Code	278
Min. Negotiated Rate	$881.02
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: Kaiser Permanente Commercial	$1,088.33
Rate for Payer: Kaiser Permanente Medicaid	$881.02
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Cement Bone Cobalt HV W/GM 600-15-100 [3641281]

Facility

$4,778.00

Service Code	HCPCS C1713
Hospital Charge Code	3641281
Hospital Revenue Code	278
Min. Negotiated Rate	$2,436.78
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: Kaiser Permanente Commercial	$3,010.14
Rate for Payer: Kaiser Permanente Medicaid	$2,436.78
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Cement Bone Cobalt HV W/GM 600-15-100 [3641281]

Facility

$4,778.00

Service Code	HCPCS C1713
Hospital Charge Code	3641281
Hospital Revenue Code	278
Min. Negotiated Rate	$2,675.68
Max. Negotiated Rate	$4,634.66
Rate for Payer: Cash Price	$3,105.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,344.60
Rate for Payer: Health Management Network Commercial	$4,061.30
Rate for Payer: MDX Hawaii PPO	$4,634.66
Rate for Payer: University Health Alliance Commercial	$2,675.68

Cement Bone Conflow 110043025 [3643320]

Facility

$565.62

Service Code	HCPCS C1713
Hospital Charge Code	3643320
Hospital Revenue Code	278
Min. Negotiated Rate	$316.75
Max. Negotiated Rate	$548.65
Rate for Payer: Cash Price	$367.65
Rate for Payer: Hawaii Western Management Group Commercial	$395.93
Rate for Payer: Health Management Network Commercial	$480.78
Rate for Payer: MDX Hawaii PPO	$548.65
Rate for Payer: University Health Alliance Commercial	$316.75

Cement Bone Conflow 110043025 [3643320]

Facility

$565.62

Service Code	HCPCS C1713
Hospital Charge Code	3643320
Hospital Revenue Code	278
Min. Negotiated Rate	$288.47
Max. Negotiated Rate	$548.65
Rate for Payer: Cash Price	$367.65
Rate for Payer: Hawaii Western Management Group Commercial	$395.93
Rate for Payer: Health Management Network Commercial	$480.78
Rate for Payer: Kaiser Permanente Commercial	$356.34
Rate for Payer: Kaiser Permanente Medicaid	$288.47
Rate for Payer: MDX Hawaii PPO	$548.65
Rate for Payer: University Health Alliance Commercial	$316.75

Cement Bone Conflow G Bone 110043026 [3642596]

Facility

$1,749.13

Service Code	HCPCS C1713
Hospital Charge Code	3642596
Hospital Revenue Code	278
Min. Negotiated Rate	$979.51
Max. Negotiated Rate	$1,696.66
Rate for Payer: Cash Price	$1,136.93
Rate for Payer: Hawaii Western Management Group Commercial	$1,224.39
Rate for Payer: Health Management Network Commercial	$1,486.76
Rate for Payer: MDX Hawaii PPO	$1,696.66
Rate for Payer: University Health Alliance Commercial	$979.51

Cement Bone Conflow G Bone 110043026 [3642596]

Facility

$1,749.13

Service Code	HCPCS C1713
Hospital Charge Code	3642596
Hospital Revenue Code	278
Min. Negotiated Rate	$892.06
Max. Negotiated Rate	$1,696.66
Rate for Payer: Cash Price	$1,136.93
Rate for Payer: Hawaii Western Management Group Commercial	$1,224.39
Rate for Payer: Health Management Network Commercial	$1,486.76
Rate for Payer: Kaiser Permanente Commercial	$1,101.95
Rate for Payer: Kaiser Permanente Medicaid	$892.06
Rate for Payer: MDX Hawaii PPO	$1,696.66
Rate for Payer: University Health Alliance Commercial	$979.51

Cement Bone Copal G+v 5184267 [3644962]

Facility

$2,978.00

Hospital Charge Code	3644962
Hospital Revenue Code	272
Min. Negotiated Rate	$2,531.30
Max. Negotiated Rate	$2,888.66
Rate for Payer: Cash Price	$1,935.70
Rate for Payer: Health Management Network Commercial	$2,531.30
Rate for Payer: MDX Hawaii PPO	$2,888.66

Cement Bone Copal G+v 5184267 [3644962]

Facility

$2,978.00

Hospital Charge Code	3644962
Hospital Revenue Code	272
Min. Negotiated Rate	$1,518.78
Max. Negotiated Rate	$2,888.66
Rate for Payer: Cash Price	$1,935.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,829.10
Rate for Payer: Health Management Network Commercial	$2,531.30
Rate for Payer: Kaiser Permanente Commercial	$1,876.14
Rate for Payer: Kaiser Permanente Medicaid	$1,518.78
Rate for Payer: MDX Hawaii PPO	$2,888.66
Rate for Payer: University Health Alliance Commercial	$2,170.66

Cement Bone R 110035368 [3642603]

Facility

$662.50

Service Code	HCPCS C1713
Hospital Charge Code	3642603
Hospital Revenue Code	278
Min. Negotiated Rate	$337.88
Max. Negotiated Rate	$642.62
Rate for Payer: Cash Price	$430.62
Rate for Payer: Hawaii Western Management Group Commercial	$463.75
Rate for Payer: Health Management Network Commercial	$563.12
Rate for Payer: Kaiser Permanente Commercial	$417.38
Rate for Payer: Kaiser Permanente Medicaid	$337.88
Rate for Payer: MDX Hawaii PPO	$642.62
Rate for Payer: University Health Alliance Commercial	$371.00

Cement Bone R 110035368 [3642603]

Facility

$662.50

Service Code	HCPCS C1713
Hospital Charge Code	3642603
Hospital Revenue Code	278
Min. Negotiated Rate	$371.00
Max. Negotiated Rate	$642.62
Rate for Payer: Cash Price	$430.62
Rate for Payer: Hawaii Western Management Group Commercial	$463.75
Rate for Payer: Health Management Network Commercial	$563.12
Rate for Payer: MDX Hawaii PPO	$642.62
Rate for Payer: University Health Alliance Commercial	$371.00

Cement Bone Vacuum Mix System 71270070 [3640235]

Facility

$1,821.03

Hospital Charge Code	3640235
Hospital Revenue Code	272
Min. Negotiated Rate	$928.73
Max. Negotiated Rate	$1,766.40
Rate for Payer: Kaiser Permanente Medicaid	$928.73
Rate for Payer: Cash Price	$1,183.67
Rate for Payer: Hawaii Western Management Group Commercial	$1,729.98
Rate for Payer: Health Management Network Commercial	$1,547.88
Rate for Payer: Kaiser Permanente Commercial	$1,147.25
Rate for Payer: MDX Hawaii PPO	$1,766.40
Rate for Payer: University Health Alliance Commercial	$1,327.35

Cement Bone Vacuum Mix System 71270070 [3640235]

Facility

$1,821.03

Hospital Charge Code	3640235
Hospital Revenue Code	272
Min. Negotiated Rate	$1,547.88
Max. Negotiated Rate	$1,766.40
Rate for Payer: Cash Price	$1,183.67
Rate for Payer: Health Management Network Commercial	$1,547.88
Rate for Payer: MDX Hawaii PPO	$1,766.40

Cement Bone w/Gent Refobacin 110034355 [3641558]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3641558
Hospital Revenue Code	278
Min. Negotiated Rate	$610.98
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: Kaiser Permanente Commercial	$754.74
Rate for Payer: Kaiser Permanente Medicaid	$610.98
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Cement Bone w/Gent Refobacin 110034355 [3641558]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3641558
Hospital Revenue Code	278
Min. Negotiated Rate	$670.88
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Cement Mixing Bowl QuickVac 5049001 [3607600]

Facility

$753.54

Hospital Charge Code	3607600
Hospital Revenue Code	272
Min. Negotiated Rate	$384.31
Max. Negotiated Rate	$730.93
Rate for Payer: Cash Price	$489.80
Rate for Payer: Hawaii Western Management Group Commercial	$715.86
Rate for Payer: Health Management Network Commercial	$640.51
Rate for Payer: Kaiser Permanente Commercial	$474.73
Rate for Payer: Kaiser Permanente Medicaid	$384.31
Rate for Payer: MDX Hawaii PPO	$730.93
Rate for Payer: University Health Alliance Commercial	$549.26

Cement Mixing Bowl QuickVac 5049001 [3607600]

Facility

$753.54

Hospital Charge Code	3607600
Hospital Revenue Code	272
Min. Negotiated Rate	$640.51
Max. Negotiated Rate	$730.93
Rate for Payer: Cash Price	$489.80
Rate for Payer: Health Management Network Commercial	$640.51
Rate for Payer: MDX Hawaii PPO	$730.93

Cement Vacuum Mixing Cartridge 540198000 [3641158]

Facility

$932.75

Hospital Charge Code	3641158
Hospital Revenue Code	272
Min. Negotiated Rate	$475.70
Max. Negotiated Rate	$904.77
Rate for Payer: Cash Price	$606.29
Rate for Payer: Hawaii Western Management Group Commercial	$886.11
Rate for Payer: Health Management Network Commercial	$792.84
Rate for Payer: Kaiser Permanente Commercial	$587.63
Rate for Payer: Kaiser Permanente Medicaid	$475.70
Rate for Payer: MDX Hawaii PPO	$904.77
Rate for Payer: University Health Alliance Commercial	$679.88

Cement Vacuum Mixing Cartridge 540198000 [3641158]

Facility

$932.75

Hospital Charge Code	3641158
Hospital Revenue Code	272
Min. Negotiated Rate	$792.84
Max. Negotiated Rate	$904.77
Rate for Payer: Cash Price	$606.29
Rate for Payer: Health Management Network Commercial	$792.84
Rate for Payer: MDX Hawaii PPO	$904.77

Know your out-of-pocket cost for care.

All Charges