Kona Community Hospital

All Charges

Charge

Type

Setting

Price

CHEMODENERVATION OF INTERNAL ANAL SPHINCTER

Facility

$6,183.00

Service Code	CPT 46505
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$1,413.65
Rate for Payer: AlohaCare Medicare	$1,413.65
Rate for Payer: Devoted Health Medicare	$1,555.02
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,413.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$1,413.65
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,413.65
Rate for Payer: Ohana Health Plan Medicaid	$1,555.02
Rate for Payer: Ohana Health Plan Medicare	$1,413.65
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,413.65

CHEMOTHERAPY ADMN IV INFUSION TQ EA HR

Professional

Both

$90.00

Service Code	HCPCS 96415
Min. Negotiated Rate	$18.25
Max. Negotiated Rate	$76.50
Rate for Payer: AlohaCare Medicaid	$18.25
Rate for Payer: AlohaCare Medicare	$31.04
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Devoted Health Medicare	$34.14
Rate for Payer: Hawaii Medical Service Association Medicare	$31.04
Rate for Payer: Hawaii Western Management Group Commercial	$36.33
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Kaiser Permanente Commercial	$37.25
Rate for Payer: Kaiser Permanente Medicaid	$37.25
Rate for Payer: Kaiser Permanente Medicare	$37.25
Rate for Payer: Ohana Health Plan Medicaid	$18.25
Rate for Payer: Ohana Health Plan Medicare	$31.04
Rate for Payer: UnitedHealthcare Medicaid	$18.25
Rate for Payer: UnitedHealthcare Medicare	$31.04

CHEMOTHERAPY FOR ACUTE LEUKEMIA

Facility

$4,393.30

Service Code	APR-DRG 6952
Min. Negotiated Rate	$4,393.30
Max. Negotiated Rate	$4,393.30
Rate for Payer: AlohaCare Medicaid	$4,393.30
Rate for Payer: Hawaii Medical Service Association ABD	$4,393.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,393.30
Rate for Payer: Kaiser Permanente Medicaid	$4,393.30
Rate for Payer: Ohana Health Plan Medicaid	$4,393.30
Rate for Payer: UnitedHealthcare Medicaid	$4,393.30

CHEMOTHERAPY FOR ACUTE LEUKEMIA

Facility

$27,225.24

Service Code	APR-DRG 6954
Min. Negotiated Rate	$27,225.24
Max. Negotiated Rate	$27,225.24
Rate for Payer: AlohaCare Medicaid	$27,225.24
Rate for Payer: Hawaii Medical Service Association ABD	$27,225.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27,225.24
Rate for Payer: Kaiser Permanente Medicaid	$27,225.24
Rate for Payer: Ohana Health Plan Medicaid	$27,225.24
Rate for Payer: UnitedHealthcare Medicaid	$27,225.24

CHEMOTHERAPY FOR ACUTE LEUKEMIA

Facility

$9,233.01

Service Code	APR-DRG 6953
Min. Negotiated Rate	$9,233.01
Max. Negotiated Rate	$9,233.01
Rate for Payer: AlohaCare Medicaid	$9,233.01
Rate for Payer: Hawaii Medical Service Association ABD	$9,233.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,233.01
Rate for Payer: Kaiser Permanente Medicaid	$9,233.01
Rate for Payer: Ohana Health Plan Medicaid	$9,233.01
Rate for Payer: UnitedHealthcare Medicaid	$9,233.01

CHEMOTHERAPY FOR ACUTE LEUKEMIA

Facility

$3,815.72

Service Code	APR-DRG 6951
Min. Negotiated Rate	$3,815.72
Max. Negotiated Rate	$3,815.72
Rate for Payer: AlohaCare Medicaid	$3,815.72
Rate for Payer: Hawaii Medical Service Association ABD	$3,815.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,815.72
Rate for Payer: Kaiser Permanente Medicaid	$3,815.72
Rate for Payer: Ohana Health Plan Medicaid	$3,815.72
Rate for Payer: UnitedHealthcare Medicaid	$3,815.72

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC

Facility

$82,874.18

Service Code	MSDRG 837
Min. Negotiated Rate	$58,965.72
Max. Negotiated Rate	$82,874.18
Rate for Payer: AlohaCare Medicare	$63,189.84
Rate for Payer: Devoted Health Medicare	$69,508.82
Rate for Payer: Hawaii Medical Service Association Commercial	$58,965.72
Rate for Payer: Hawaii Medical Service Association Medicare	$63,189.84
Rate for Payer: Humana Medicare	$63,189.84
Rate for Payer: Kaiser Permanente Commercial	$82,874.18
Rate for Payer: Kaiser Permanente Medicare	$63,189.84
Rate for Payer: Ohana Health Plan Medicare	$63,189.84
Rate for Payer: UnitedHealthcare Medicare	$63,189.84

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT

Facility

$58,965.72

Service Code	MSDRG 838
Min. Negotiated Rate	$27,455.09
Max. Negotiated Rate	$58,965.72
Rate for Payer: AlohaCare Medicare	$27,455.09
Rate for Payer: Devoted Health Medicare	$30,200.60
Rate for Payer: Hawaii Medical Service Association Commercial	$58,965.72
Rate for Payer: Hawaii Medical Service Association Medicare	$27,455.09
Rate for Payer: Humana Medicare	$27,455.09
Rate for Payer: Kaiser Permanente Commercial	$36,007.65
Rate for Payer: Kaiser Permanente Medicare	$27,455.09
Rate for Payer: Ohana Health Plan Medicare	$27,455.09
Rate for Payer: UnitedHealthcare Medicare	$27,455.09

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$58,965.72

Service Code	MSDRG 839
Min. Negotiated Rate	$18,991.28
Max. Negotiated Rate	$58,965.72
Rate for Payer: AlohaCare Medicare	$18,991.28
Rate for Payer: Devoted Health Medicare	$20,890.41
Rate for Payer: Hawaii Medical Service Association Commercial	$58,965.72
Rate for Payer: Hawaii Medical Service Association Medicare	$18,991.28
Rate for Payer: Humana Medicare	$18,991.28
Rate for Payer: Kaiser Permanente Commercial	$24,907.28
Rate for Payer: Kaiser Permanente Medicare	$18,991.28
Rate for Payer: Ohana Health Plan Medicare	$18,991.28
Rate for Payer: UnitedHealthcare Medicare	$18,991.28

CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC

Facility

$22,566.45

Service Code	MSDRG 847
Min. Negotiated Rate	$17,206.46
Max. Negotiated Rate	$22,566.45
Rate for Payer: AlohaCare Medicare	$17,206.46
Rate for Payer: Devoted Health Medicare	$18,927.11
Rate for Payer: Hawaii Medical Service Association Commercial	$18,827.57
Rate for Payer: Hawaii Medical Service Association Medicare	$17,206.46
Rate for Payer: Humana Medicare	$17,206.46
Rate for Payer: Kaiser Permanente Commercial	$22,566.45
Rate for Payer: Kaiser Permanente Medicare	$17,206.46
Rate for Payer: Ohana Health Plan Medicare	$17,206.46
Rate for Payer: UnitedHealthcare Medicare	$17,206.46

CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC

Facility

$44,720.62

Service Code	MSDRG 846
Min. Negotiated Rate	$18,827.57
Max. Negotiated Rate	$44,720.62
Rate for Payer: AlohaCare Medicare	$34,098.54
Rate for Payer: Devoted Health Medicare	$37,508.39
Rate for Payer: Hawaii Medical Service Association Commercial	$18,827.57
Rate for Payer: Hawaii Medical Service Association Medicare	$34,098.54
Rate for Payer: Humana Medicare	$34,098.54
Rate for Payer: Kaiser Permanente Commercial	$44,720.62
Rate for Payer: Kaiser Permanente Medicare	$34,098.54
Rate for Payer: Ohana Health Plan Medicare	$34,098.54
Rate for Payer: UnitedHealthcare Medicare	$34,098.54

CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$18,827.57

Service Code	MSDRG 848
Min. Negotiated Rate	$11,171.96
Max. Negotiated Rate	$18,827.57
Rate for Payer: AlohaCare Medicare	$11,171.96
Rate for Payer: Devoted Health Medicare	$12,289.16
Rate for Payer: Hawaii Medical Service Association Commercial	$18,827.57
Rate for Payer: Hawaii Medical Service Association Medicare	$11,171.96
Rate for Payer: Humana Medicare	$11,171.96
Rate for Payer: Kaiser Permanente Commercial	$14,652.15
Rate for Payer: Kaiser Permanente Medicare	$11,171.96
Rate for Payer: Ohana Health Plan Medicare	$11,171.96
Rate for Payer: UnitedHealthcare Medicare	$11,171.96

CHEMOTX ADM IV INF TECH; INI INF OFFICE/CLIN SET

Professional

Both

$429.00

Service Code	HCPCS G0498
Min. Negotiated Rate	$182.91
Max. Negotiated Rate	$364.65
Rate for Payer: Cash Price	$278.85
Rate for Payer: Cash Price	$278.85
Rate for Payer: Hawaii Western Management Group Commercial	$182.91
Rate for Payer: Health Management Network Commercial	$364.65

CHEMOTX ADMN CNS REQ SPINAL PUNCTURE

Professional

Both

$526.00

Service Code	HCPCS 96450
Min. Negotiated Rate	$45.67
Max. Negotiated Rate	$447.10
Rate for Payer: AlohaCare Medicaid	$45.67
Rate for Payer: AlohaCare Medicare	$65.96
Rate for Payer: Cash Price	$341.90
Rate for Payer: Cash Price	$341.90
Rate for Payer: Devoted Health Medicare	$72.56
Rate for Payer: Hawaii Medical Service Association ABD	$76.11
Rate for Payer: Hawaii Medical Service Association Commercial	$134.69
Rate for Payer: Hawaii Medical Service Association Medicare	$65.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$76.11
Rate for Payer: Hawaii Western Management Group Commercial	$104.27
Rate for Payer: Health Management Network Commercial	$447.10
Rate for Payer: Kaiser Permanente Commercial	$79.15
Rate for Payer: Kaiser Permanente Medicaid	$79.15
Rate for Payer: Kaiser Permanente Medicare	$79.15
Rate for Payer: Ohana Health Plan Medicaid	$45.67
Rate for Payer: Ohana Health Plan Medicare	$65.96
Rate for Payer: UnitedHealthcare Medicaid	$45.67
Rate for Payer: UnitedHealthcare Medicare	$65.96
Rate for Payer: University Health Alliance Commercial	$96.88

CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR

Professional

Both

$196.00

Service Code	HCPCS 96417
Min. Negotiated Rate	$42.74
Max. Negotiated Rate	$166.60
Rate for Payer: AlohaCare Medicaid	$42.74
Rate for Payer: AlohaCare Medicare	$74.05
Rate for Payer: Cash Price	$127.40
Rate for Payer: Cash Price	$127.40
Rate for Payer: Devoted Health Medicare	$81.45
Rate for Payer: Hawaii Medical Service Association Medicare	$74.05
Rate for Payer: Hawaii Western Management Group Commercial	$80.18
Rate for Payer: Health Management Network Commercial	$166.60
Rate for Payer: Kaiser Permanente Commercial	$88.86
Rate for Payer: Kaiser Permanente Medicaid	$88.86
Rate for Payer: Kaiser Permanente Medicare	$88.86
Rate for Payer: Ohana Health Plan Medicaid	$42.74
Rate for Payer: Ohana Health Plan Medicare	$74.05
Rate for Payer: UnitedHealthcare Medicaid	$42.74
Rate for Payer: UnitedHealthcare Medicare	$74.05

CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG

Professional

Both

$424.00

Service Code	HCPCS 96413
Min. Negotiated Rate	$87.38
Max. Negotiated Rate	$360.40
Rate for Payer: AlohaCare Medicaid	$87.38
Rate for Payer: AlohaCare Medicare	$148.94
Rate for Payer: Cash Price	$275.60
Rate for Payer: Cash Price	$275.60
Rate for Payer: Devoted Health Medicare	$163.83
Rate for Payer: Hawaii Medical Service Association Medicare	$148.94
Rate for Payer: Hawaii Western Management Group Commercial	$165.13
Rate for Payer: Health Management Network Commercial	$360.40
Rate for Payer: Kaiser Permanente Commercial	$178.73
Rate for Payer: Kaiser Permanente Medicaid	$178.73
Rate for Payer: Kaiser Permanente Medicare	$178.73
Rate for Payer: Ohana Health Plan Medicaid	$87.38
Rate for Payer: Ohana Health Plan Medicare	$148.94
Rate for Payer: UnitedHealthcare Medicaid	$87.38
Rate for Payer: UnitedHealthcare Medicare	$148.94

CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG

Professional

Both

$327.00

Service Code	HCPCS 96409
Min. Negotiated Rate	$40.87
Max. Negotiated Rate	$277.95
Rate for Payer: AlohaCare Medicaid	$67.43
Rate for Payer: AlohaCare Medicare	$116.65
Rate for Payer: Cash Price	$212.55
Rate for Payer: Cash Price	$212.55
Rate for Payer: Devoted Health Medicare	$128.31
Rate for Payer: Hawaii Medical Service Association Medicare	$116.65
Rate for Payer: Hawaii Western Management Group Commercial	$40.87
Rate for Payer: Health Management Network Commercial	$277.95
Rate for Payer: Kaiser Permanente Commercial	$139.98
Rate for Payer: Kaiser Permanente Medicaid	$139.98
Rate for Payer: Kaiser Permanente Medicare	$139.98
Rate for Payer: Ohana Health Plan Medicaid	$67.43
Rate for Payer: Ohana Health Plan Medicare	$116.65
Rate for Payer: UnitedHealthcare Medicaid	$67.43
Rate for Payer: UnitedHealthcare Medicare	$116.65

CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG

Professional

Both

$178.00

Service Code	HCPCS 96411
Min. Negotiated Rate	$36.46
Max. Negotiated Rate	$151.30
Rate for Payer: AlohaCare Medicaid	$36.46
Rate for Payer: AlohaCare Medicare	$63.47
Rate for Payer: Cash Price	$115.70
Rate for Payer: Cash Price	$115.70
Rate for Payer: Devoted Health Medicare	$69.82
Rate for Payer: Hawaii Medical Service Association Medicare	$63.47
Rate for Payer: Hawaii Western Management Group Commercial	$67.14
Rate for Payer: Health Management Network Commercial	$151.30
Rate for Payer: Kaiser Permanente Commercial	$76.16
Rate for Payer: Kaiser Permanente Medicaid	$76.16
Rate for Payer: Kaiser Permanente Medicare	$76.16
Rate for Payer: Ohana Health Plan Medicaid	$36.46
Rate for Payer: Ohana Health Plan Medicare	$63.47
Rate for Payer: UnitedHealthcare Medicaid	$36.46
Rate for Payer: UnitedHealthcare Medicare	$63.47

CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO

Professional

Both

$102.00

Service Code	HCPCS 96402
Min. Negotiated Rate	$23.53
Max. Negotiated Rate	$86.70
Rate for Payer: AlohaCare Medicaid	$23.53
Rate for Payer: AlohaCare Medicare	$42.81
Rate for Payer: Cash Price	$66.30
Rate for Payer: Cash Price	$66.30
Rate for Payer: Devoted Health Medicare	$47.09
Rate for Payer: Hawaii Medical Service Association Medicare	$42.81
Rate for Payer: Hawaii Western Management Group Commercial	$33.65
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: Kaiser Permanente Commercial	$51.37
Rate for Payer: Kaiser Permanente Medicaid	$51.37
Rate for Payer: Kaiser Permanente Medicare	$51.37
Rate for Payer: Ohana Health Plan Medicaid	$23.53
Rate for Payer: Ohana Health Plan Medicare	$42.81
Rate for Payer: UnitedHealthcare Medicaid	$23.53
Rate for Payer: UnitedHealthcare Medicare	$42.81

CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO

Professional

Both

$235.00

Service Code	HCPCS 96401
Min. Negotiated Rate	$48.24
Max. Negotiated Rate	$199.75
Rate for Payer: AlohaCare Medicaid	$48.24
Rate for Payer: AlohaCare Medicare	$79.94
Rate for Payer: Cash Price	$152.75
Rate for Payer: Cash Price	$152.75
Rate for Payer: Devoted Health Medicare	$87.93
Rate for Payer: Hawaii Medical Service Association Medicare	$79.94
Rate for Payer: Hawaii Western Management Group Commercial	$58.35
Rate for Payer: Health Management Network Commercial	$199.75
Rate for Payer: Kaiser Permanente Commercial	$95.93
Rate for Payer: Kaiser Permanente Medicaid	$95.93
Rate for Payer: Kaiser Permanente Medicare	$95.93
Rate for Payer: Ohana Health Plan Medicaid	$48.24
Rate for Payer: Ohana Health Plan Medicare	$79.94
Rate for Payer: UnitedHealthcare Medicaid	$48.24
Rate for Payer: UnitedHealthcare Medicare	$79.94

CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP

Professional

Both

$415.00

Service Code	HCPCS 96416
Min. Negotiated Rate	$86.22
Max. Negotiated Rate	$352.75
Rate for Payer: AlohaCare Medicaid	$86.22
Rate for Payer: AlohaCare Medicare	$149.26
Rate for Payer: Cash Price	$269.75
Rate for Payer: Cash Price	$269.75
Rate for Payer: Devoted Health Medicare	$164.19
Rate for Payer: Hawaii Medical Service Association Medicare	$149.26
Rate for Payer: Hawaii Western Management Group Commercial	$177.82
Rate for Payer: Health Management Network Commercial	$352.75
Rate for Payer: Kaiser Permanente Commercial	$179.11
Rate for Payer: Kaiser Permanente Medicaid	$179.11
Rate for Payer: Kaiser Permanente Medicare	$179.11
Rate for Payer: Ohana Health Plan Medicaid	$86.22
Rate for Payer: Ohana Health Plan Medicare	$149.26
Rate for Payer: UnitedHealthcare Medicaid	$86.22
Rate for Payer: UnitedHealthcare Medicare	$149.26

CHEST PAIN

Facility

$2,532.57

Service Code	APR-DRG 2031
Min. Negotiated Rate	$2,532.57
Max. Negotiated Rate	$2,532.57
Rate for Payer: AlohaCare Medicaid	$2,532.57
Rate for Payer: Hawaii Medical Service Association ABD	$2,532.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,532.57
Rate for Payer: Kaiser Permanente Medicaid	$2,532.57
Rate for Payer: Ohana Health Plan Medicaid	$2,532.57
Rate for Payer: UnitedHealthcare Medicaid	$2,532.57

CHEST PAIN

Facility

$2,947.12

Service Code	APR-DRG 2032
Min. Negotiated Rate	$2,947.12
Max. Negotiated Rate	$2,947.12
Rate for Payer: AlohaCare Medicaid	$2,947.12
Rate for Payer: Hawaii Medical Service Association ABD	$2,947.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,947.12
Rate for Payer: Kaiser Permanente Medicaid	$2,947.12
Rate for Payer: Ohana Health Plan Medicaid	$2,947.12
Rate for Payer: UnitedHealthcare Medicaid	$2,947.12

CHEST PAIN

Facility

$3,633.60

Service Code	APR-DRG 2033
Min. Negotiated Rate	$3,633.60
Max. Negotiated Rate	$3,633.60
Rate for Payer: AlohaCare Medicaid	$3,633.60
Rate for Payer: Hawaii Medical Service Association ABD	$3,633.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,633.60
Rate for Payer: Kaiser Permanente Medicaid	$3,633.60
Rate for Payer: Ohana Health Plan Medicaid	$3,633.60
Rate for Payer: UnitedHealthcare Medicaid	$3,633.60

CHEST PAIN

Facility

$12,420.00

Service Code	MSDRG 313
Min. Negotiated Rate	$9,469.99
Max. Negotiated Rate	$12,420.00
Rate for Payer: AlohaCare Medicare	$9,469.99
Rate for Payer: Devoted Health Medicare	$10,416.99
Rate for Payer: Hawaii Medical Service Association Commercial	$11,643.68
Rate for Payer: Hawaii Medical Service Association Medicare	$9,469.99
Rate for Payer: Humana Medicare	$9,469.99
Rate for Payer: Kaiser Permanente Commercial	$12,420.00
Rate for Payer: Kaiser Permanente Medicare	$9,469.99
Rate for Payer: Ohana Health Plan Medicare	$9,469.99
Rate for Payer: UnitedHealthcare Medicare	$9,469.99

Know your out-of-pocket cost for care.

All Charges