Kona Community Hospital

All Charges

Charge

Type

Setting

Price

CHOLECALCIFEROL (VITAMIN D3) 5000 UNIT PO CAP

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Cash Price	$1.35
Rate for Payer: Hawaii Western Management Group Commercial	$1.97
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$1.76
Rate for Payer: Kaiser Permanente Commercial	$1.30
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicaid	$1.06
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$2.01
Rate for Payer: UnitedHealthcare Medicaid	$1.24
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87
Rate for Payer: University Health Alliance Commercial	$1.51

CHOLECALCIFEROL (VITAMIN D3) 5000 UNIT PO CAP

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Cash Price	$1.35
Rate for Payer: Health Management Network Commercial	$1.76
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$2.01

CHOLECYSTECTOMY

Facility

$5,770.71

Service Code	APR-DRG 2631
Min. Negotiated Rate	$5,770.71
Max. Negotiated Rate	$5,770.71
Rate for Payer: AlohaCare Medicaid	$5,770.71
Rate for Payer: Hawaii Medical Service Association ABD	$5,770.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,770.71
Rate for Payer: Kaiser Permanente Medicaid	$5,770.71
Rate for Payer: Ohana Health Plan Medicaid	$5,770.71
Rate for Payer: UnitedHealthcare Medicaid	$5,770.71

CHOLECYSTECTOMY

Facility

$9,457.16

Service Code	APR-DRG 2633
Min. Negotiated Rate	$9,457.16
Max. Negotiated Rate	$9,457.16
Rate for Payer: AlohaCare Medicaid	$9,457.16
Rate for Payer: Hawaii Medical Service Association ABD	$9,457.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,457.16
Rate for Payer: Kaiser Permanente Medicaid	$9,457.16
Rate for Payer: Ohana Health Plan Medicaid	$9,457.16
Rate for Payer: UnitedHealthcare Medicaid	$9,457.16

CHOLECYSTECTOMY

Facility

$7,310.50

Service Code	APR-DRG 2632
Min. Negotiated Rate	$7,310.50
Max. Negotiated Rate	$7,310.50
Rate for Payer: AlohaCare Medicaid	$7,310.50
Rate for Payer: Hawaii Medical Service Association ABD	$7,310.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,310.50
Rate for Payer: Kaiser Permanente Medicaid	$7,310.50
Rate for Payer: Ohana Health Plan Medicaid	$7,310.50
Rate for Payer: UnitedHealthcare Medicaid	$7,310.50

CHOLECYSTECTOMY

Facility

$16,747.92

Service Code	APR-DRG 2634
Min. Negotiated Rate	$16,747.92
Max. Negotiated Rate	$16,747.92
Rate for Payer: AlohaCare Medicaid	$16,747.92
Rate for Payer: Hawaii Medical Service Association ABD	$16,747.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16,747.92
Rate for Payer: Kaiser Permanente Medicaid	$16,747.92
Rate for Payer: Ohana Health Plan Medicaid	$16,747.92
Rate for Payer: UnitedHealthcare Medicaid	$16,747.92

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC

Facility

$39,222.09

Service Code	MSDRG 415
Min. Negotiated Rate	$27,182.83
Max. Negotiated Rate	$39,222.09
Rate for Payer: AlohaCare Medicare	$27,182.83
Rate for Payer: Devoted Health Medicare	$29,901.11
Rate for Payer: Hawaii Medical Service Association Commercial	$39,222.09
Rate for Payer: Hawaii Medical Service Association Medicare	$27,182.83
Rate for Payer: Humana Medicare	$27,182.83
Rate for Payer: Kaiser Permanente Commercial	$35,650.57
Rate for Payer: Kaiser Permanente Medicare	$27,182.83
Rate for Payer: Ohana Health Plan Medicare	$27,182.83
Rate for Payer: UnitedHealthcare Medicare	$27,182.83

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC

Facility

$61,454.85

Service Code	MSDRG 414
Min. Negotiated Rate	$42,139.04
Max. Negotiated Rate	$61,454.85
Rate for Payer: AlohaCare Medicare	$46,858.05
Rate for Payer: Devoted Health Medicare	$51,543.86
Rate for Payer: Hawaii Medical Service Association Commercial	$42,139.04
Rate for Payer: Hawaii Medical Service Association Medicare	$46,858.05
Rate for Payer: Humana Medicare	$46,858.05
Rate for Payer: Kaiser Permanente Commercial	$61,454.85
Rate for Payer: Kaiser Permanente Medicare	$46,858.05
Rate for Payer: Ohana Health Plan Medicare	$46,858.05
Rate for Payer: UnitedHealthcare Medicare	$46,858.05

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$27,240.91

Service Code	MSDRG 416
Min. Negotiated Rate	$17,931.18
Max. Negotiated Rate	$27,240.91
Rate for Payer: AlohaCare Medicare	$17,931.18
Rate for Payer: Devoted Health Medicare	$19,724.30
Rate for Payer: Hawaii Medical Service Association Commercial	$27,240.91
Rate for Payer: Hawaii Medical Service Association Medicare	$17,931.18
Rate for Payer: Humana Medicare	$17,931.18
Rate for Payer: Kaiser Permanente Commercial	$23,516.92
Rate for Payer: Kaiser Permanente Medicare	$17,931.18
Rate for Payer: Ohana Health Plan Medicare	$17,931.18
Rate for Payer: UnitedHealthcare Medicare	$17,931.18

CHOLECYSTECTOMY WITH C.D.E. WITH CC

Facility

$42,597.07

Service Code	MSDRG 412
Min. Negotiated Rate	$27,653.69
Max. Negotiated Rate	$42,597.07
Rate for Payer: AlohaCare Medicare	$27,653.69
Rate for Payer: Devoted Health Medicare	$30,419.06
Rate for Payer: Hawaii Medical Service Association Commercial	$42,597.07
Rate for Payer: Hawaii Medical Service Association Medicare	$27,653.69
Rate for Payer: Humana Medicare	$27,653.69
Rate for Payer: Kaiser Permanente Commercial	$36,268.12
Rate for Payer: Kaiser Permanente Medicare	$27,653.69
Rate for Payer: Ohana Health Plan Medicare	$27,653.69
Rate for Payer: UnitedHealthcare Medicare	$27,653.69

CHOLECYSTECTOMY WITH C.D.E. WITH MCC

Facility

$56,981.93

Service Code	MSDRG 411
Min. Negotiated Rate	$43,447.53
Max. Negotiated Rate	$56,981.93
Rate for Payer: AlohaCare Medicare	$43,447.53
Rate for Payer: Devoted Health Medicare	$47,792.28
Rate for Payer: Hawaii Medical Service Association Commercial	$50,938.09
Rate for Payer: Hawaii Medical Service Association Medicare	$43,447.53
Rate for Payer: Humana Medicare	$43,447.53
Rate for Payer: Kaiser Permanente Commercial	$56,981.93
Rate for Payer: Kaiser Permanente Medicare	$43,447.53
Rate for Payer: Ohana Health Plan Medicare	$43,447.53
Rate for Payer: UnitedHealthcare Medicare	$43,447.53

CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC

Facility

$34,280.15

Service Code	MSDRG 413
Min. Negotiated Rate	$21,840.17
Max. Negotiated Rate	$34,280.15
Rate for Payer: AlohaCare Medicare	$21,840.17
Rate for Payer: Devoted Health Medicare	$24,024.19
Rate for Payer: Hawaii Medical Service Association Commercial	$34,280.15
Rate for Payer: Hawaii Medical Service Association Medicare	$21,840.17
Rate for Payer: Humana Medicare	$21,840.17
Rate for Payer: Kaiser Permanente Commercial	$28,643.62
Rate for Payer: Kaiser Permanente Medicare	$21,840.17
Rate for Payer: Ohana Health Plan Medicare	$21,840.17
Rate for Payer: UnitedHealthcare Medicare	$21,840.17

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM PO PWPK

Facility

$18.60

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$15.81
Max. Negotiated Rate	$18.04
Rate for Payer: Cash Price	$12.09
Rate for Payer: Health Management Network Commercial	$15.81
Rate for Payer: MDX Hawaii PPO	$18.04

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM PO PWPK

Facility

$18.60

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$18.04
Rate for Payer: Cash Price	$12.09
Rate for Payer: Hawaii Western Management Group Commercial	$17.67
Rate for Payer: Health Management Network Commercial	$15.81
Rate for Payer: Kaiser Permanente Commercial	$11.72
Rate for Payer: Kaiser Permanente Medicaid	$9.49
Rate for Payer: MDX Hawaii PPO	$18.04
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: University Health Alliance Commercial	$13.56

Chondral Dart 18mm AR-4005B-18 [3644636]

Facility

$807.35

Service Code	HCPCS C1713
Hospital Charge Code	3644636
Hospital Revenue Code	278
Min. Negotiated Rate	$411.75
Max. Negotiated Rate	$783.13
Rate for Payer: Cash Price	$524.78
Rate for Payer: Hawaii Western Management Group Commercial	$565.14
Rate for Payer: Health Management Network Commercial	$686.25
Rate for Payer: Kaiser Permanente Commercial	$508.63
Rate for Payer: Kaiser Permanente Medicaid	$411.75
Rate for Payer: MDX Hawaii PPO	$783.13
Rate for Payer: University Health Alliance Commercial	$452.12

Chondral Dart 18mm AR-4005B-18 [3644636]

Facility

$807.35

Service Code	HCPCS C1713
Hospital Charge Code	3644636
Hospital Revenue Code	278
Min. Negotiated Rate	$452.12
Max. Negotiated Rate	$783.13
Rate for Payer: Cash Price	$524.78
Rate for Payer: Hawaii Western Management Group Commercial	$565.14
Rate for Payer: Health Management Network Commercial	$686.25
Rate for Payer: MDX Hawaii PPO	$783.13
Rate for Payer: University Health Alliance Commercial	$452.12

CHONDROITIN SULF-SOD HYALURON 4-3 % (40-30 MG/ML) INTRAOC SYR

Facility

$651.61

Service Code	NDC 08065183905
Hospital Revenue Code	250
Min. Negotiated Rate	$553.87
Max. Negotiated Rate	$632.06
Rate for Payer: Cash Price	$423.55
Rate for Payer: Health Management Network Commercial	$553.87
Rate for Payer: MDX Hawaii PPO	$632.06

CHONDROITIN SULF-SOD HYALURON 4-3 % (40-30 MG/ML) INTRAOC SYR

Facility

$651.61

Service Code	NDC 08065183905
Hospital Revenue Code	250
Min. Negotiated Rate	$332.32
Max. Negotiated Rate	$632.06
Rate for Payer: Cash Price	$423.55
Rate for Payer: Hawaii Western Management Group Commercial	$619.03
Rate for Payer: Health Management Network Commercial	$553.87
Rate for Payer: Kaiser Permanente Commercial	$410.51
Rate for Payer: Kaiser Permanente Medicaid	$332.32
Rate for Payer: MDX Hawaii PPO	$632.06
Rate for Payer: UnitedHealthcare Medicaid	$390.97
Rate for Payer: University Health Alliance Commercial	$474.96

CHRONIC KIDNEY DISEASE

Facility

$3,041.37

Service Code	APR-DRG 4702
Min. Negotiated Rate	$3,041.37
Max. Negotiated Rate	$3,041.37
Rate for Payer: AlohaCare Medicaid	$3,041.37
Rate for Payer: Hawaii Medical Service Association ABD	$3,041.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,041.37
Rate for Payer: Kaiser Permanente Medicaid	$3,041.37
Rate for Payer: Ohana Health Plan Medicaid	$3,041.37
Rate for Payer: UnitedHealthcare Medicaid	$3,041.37

CHRONIC KIDNEY DISEASE

Facility

$7,430.85

Service Code	APR-DRG 4704
Min. Negotiated Rate	$7,430.85
Max. Negotiated Rate	$7,430.85
Rate for Payer: AlohaCare Medicaid	$7,430.85
Rate for Payer: Hawaii Medical Service Association ABD	$7,430.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,430.85
Rate for Payer: Kaiser Permanente Medicaid	$7,430.85
Rate for Payer: Ohana Health Plan Medicaid	$7,430.85
Rate for Payer: UnitedHealthcare Medicaid	$7,430.85

CHRONIC KIDNEY DISEASE

Facility

$2,499.45

Service Code	APR-DRG 4701
Min. Negotiated Rate	$2,499.45
Max. Negotiated Rate	$2,499.45
Rate for Payer: AlohaCare Medicaid	$2,499.45
Rate for Payer: Hawaii Medical Service Association ABD	$2,499.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,499.45
Rate for Payer: Kaiser Permanente Medicaid	$2,499.45
Rate for Payer: Ohana Health Plan Medicaid	$2,499.45
Rate for Payer: UnitedHealthcare Medicaid	$2,499.45

CHRONIC KIDNEY DISEASE

Facility

$4,357.01

Service Code	APR-DRG 4703
Min. Negotiated Rate	$4,357.01
Max. Negotiated Rate	$4,357.01
Rate for Payer: AlohaCare Medicaid	$4,357.01
Rate for Payer: Hawaii Medical Service Association ABD	$4,357.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,357.01
Rate for Payer: Kaiser Permanente Medicaid	$4,357.01
Rate for Payer: Ohana Health Plan Medicaid	$4,357.01
Rate for Payer: UnitedHealthcare Medicaid	$4,357.01

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Facility

$2,803.21

Service Code	APR-DRG 1401
Min. Negotiated Rate	$2,803.21
Max. Negotiated Rate	$2,803.21
Rate for Payer: AlohaCare Medicaid	$2,803.21
Rate for Payer: Hawaii Medical Service Association ABD	$2,803.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,803.21
Rate for Payer: Kaiser Permanente Medicaid	$2,803.21
Rate for Payer: Ohana Health Plan Medicaid	$2,803.21
Rate for Payer: UnitedHealthcare Medicaid	$2,803.21

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Facility

$3,438.74

Service Code	APR-DRG 1402
Min. Negotiated Rate	$3,438.74
Max. Negotiated Rate	$3,438.74
Rate for Payer: AlohaCare Medicaid	$3,438.74
Rate for Payer: Hawaii Medical Service Association ABD	$3,438.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,438.74
Rate for Payer: Kaiser Permanente Medicaid	$3,438.74
Rate for Payer: Ohana Health Plan Medicaid	$3,438.74
Rate for Payer: UnitedHealthcare Medicaid	$3,438.74

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Facility

$4,271.67

Service Code	APR-DRG 1403
Min. Negotiated Rate	$4,271.67
Max. Negotiated Rate	$4,271.67
Rate for Payer: AlohaCare Medicaid	$4,271.67
Rate for Payer: Hawaii Medical Service Association ABD	$4,271.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,271.67
Rate for Payer: Kaiser Permanente Medicaid	$4,271.67
Rate for Payer: Ohana Health Plan Medicaid	$4,271.67
Rate for Payer: UnitedHealthcare Medicaid	$4,271.67

Know your out-of-pocket cost for care.

All Charges