Kona Community Hospital

All Charges

Charge

Type

Setting

Price

COCAINE 4 % NASAL SOLN

Facility

$1,134.35

Service Code	HCPCS C9046
Hospital Revenue Code	250
Min. Negotiated Rate	$964.20
Max. Negotiated Rate	$1,100.32
Rate for Payer: Cash Price	$737.33
Rate for Payer: Health Management Network Commercial	$964.20
Rate for Payer: MDX Hawaii PPO	$1,100.32

COCAINE ABUSE & DEPENDENCE

Facility

$4,320.71

Service Code	APR-DRG 7743
Min. Negotiated Rate	$4,320.71
Max. Negotiated Rate	$4,320.71
Rate for Payer: AlohaCare Medicaid	$4,320.71
Rate for Payer: Hawaii Medical Service Association ABD	$4,320.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,320.71
Rate for Payer: Kaiser Permanente Medicaid	$4,320.71
Rate for Payer: Ohana Health Plan Medicaid	$4,320.71
Rate for Payer: UnitedHealthcare Medicaid	$4,320.71

COCAINE ABUSE & DEPENDENCE

Facility

$2,304.62

Service Code	APR-DRG 7741
Min. Negotiated Rate	$2,304.62
Max. Negotiated Rate	$2,304.62
Rate for Payer: AlohaCare Medicaid	$2,304.62
Rate for Payer: Hawaii Medical Service Association ABD	$2,304.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,304.62
Rate for Payer: Kaiser Permanente Medicaid	$2,304.62
Rate for Payer: Ohana Health Plan Medicaid	$2,304.62
Rate for Payer: UnitedHealthcare Medicaid	$2,304.62

COCAINE ABUSE & DEPENDENCE

Facility

$2,433.51

Service Code	APR-DRG 7742
Min. Negotiated Rate	$2,433.51
Max. Negotiated Rate	$2,433.51
Rate for Payer: AlohaCare Medicaid	$2,433.51
Rate for Payer: Hawaii Medical Service Association ABD	$2,433.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,433.51
Rate for Payer: Kaiser Permanente Medicaid	$2,433.51
Rate for Payer: Ohana Health Plan Medicaid	$2,433.51
Rate for Payer: UnitedHealthcare Medicaid	$2,433.51

COCAINE ABUSE & DEPENDENCE

Facility

$12,371.14

Service Code	APR-DRG 7744
Min. Negotiated Rate	$12,371.14
Max. Negotiated Rate	$12,371.14
Rate for Payer: AlohaCare Medicaid	$12,371.14
Rate for Payer: Hawaii Medical Service Association ABD	$12,371.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,371.14
Rate for Payer: Kaiser Permanente Medicaid	$12,371.14
Rate for Payer: Ohana Health Plan Medicaid	$12,371.14
Rate for Payer: UnitedHealthcare Medicaid	$12,371.14

CoCr Femoral Head 28mm +0 12/14 Taper 138-2800 [3644516]

Facility

$3,878.00

Service Code	HCPCS C1776
Hospital Charge Code	3644516
Hospital Revenue Code	278
Min. Negotiated Rate	$1,977.78
Max. Negotiated Rate	$3,761.66
Rate for Payer: Cash Price	$2,520.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,714.60
Rate for Payer: Health Management Network Commercial	$3,296.30
Rate for Payer: Kaiser Permanente Commercial	$2,443.14
Rate for Payer: Kaiser Permanente Medicaid	$1,977.78
Rate for Payer: MDX Hawaii PPO	$3,761.66
Rate for Payer: University Health Alliance Commercial	$2,171.68

CoCr Femoral Head 28mm +0 12/14 Taper 138-2800 [3644516]

Facility

$3,878.00

Service Code	HCPCS C1776
Hospital Charge Code	3644516
Hospital Revenue Code	278
Min. Negotiated Rate	$2,171.68
Max. Negotiated Rate	$3,761.66
Rate for Payer: Cash Price	$2,520.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,714.60
Rate for Payer: Health Management Network Commercial	$3,296.30
Rate for Payer: MDX Hawaii PPO	$3,761.66
Rate for Payer: University Health Alliance Commercial	$2,171.68

COLCHICINE 0.6 MG PO TABLET

Facility

$44.41

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$22.65
Max. Negotiated Rate	$43.08
Rate for Payer: Cash Price	$28.87
Rate for Payer: Cash Price	$27.42
Rate for Payer: Hawaii Western Management Group Commercial	$42.19
Rate for Payer: Hawaii Western Management Group Commercial	$40.07
Rate for Payer: Health Management Network Commercial	$35.85
Rate for Payer: Health Management Network Commercial	$37.75
Rate for Payer: Kaiser Permanente Commercial	$26.57
Rate for Payer: Kaiser Permanente Commercial	$27.98
Rate for Payer: Kaiser Permanente Medicaid	$21.51
Rate for Payer: Kaiser Permanente Medicaid	$22.65
Rate for Payer: MDX Hawaii PPO	$40.91
Rate for Payer: MDX Hawaii PPO	$43.08
Rate for Payer: UnitedHealthcare Medicaid	$26.65
Rate for Payer: UnitedHealthcare Medicaid	$25.31
Rate for Payer: University Health Alliance Commercial	$30.75
Rate for Payer: University Health Alliance Commercial	$32.37

COLCHICINE 0.6 MG PO TABLET

Facility

$42.18

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$40.91
Rate for Payer: Cash Price	$27.42
Rate for Payer: Cash Price	$28.87
Rate for Payer: Health Management Network Commercial	$35.85
Rate for Payer: Health Management Network Commercial	$37.75
Rate for Payer: MDX Hawaii PPO	$43.08
Rate for Payer: MDX Hawaii PPO	$40.91

COLESTIPOL 1 GRAM PO TABLET

Facility

$27.63

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$14.09
Max. Negotiated Rate	$26.80
Rate for Payer: Cash Price	$17.96
Rate for Payer: Cash Price	$4.45
Rate for Payer: Hawaii Western Management Group Commercial	$26.25
Rate for Payer: Hawaii Western Management Group Commercial	$6.50
Rate for Payer: Health Management Network Commercial	$23.49
Rate for Payer: Health Management Network Commercial	$5.81
Rate for Payer: Kaiser Permanente Commercial	$17.41
Rate for Payer: Kaiser Permanente Commercial	$4.31
Rate for Payer: Kaiser Permanente Medicaid	$14.09
Rate for Payer: Kaiser Permanente Medicaid	$3.49
Rate for Payer: MDX Hawaii PPO	$26.80
Rate for Payer: MDX Hawaii PPO	$6.63
Rate for Payer: UnitedHealthcare Medicaid	$4.10
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: University Health Alliance Commercial	$20.14
Rate for Payer: University Health Alliance Commercial	$4.99

COLESTIPOL 1 GRAM PO TABLET

Facility

$27.63

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$23.49
Max. Negotiated Rate	$26.80
Rate for Payer: Cash Price	$17.96
Rate for Payer: Cash Price	$4.45
Rate for Payer: Health Management Network Commercial	$23.49
Rate for Payer: Health Management Network Commercial	$5.81
Rate for Payer: MDX Hawaii PPO	$26.80
Rate for Payer: MDX Hawaii PPO	$6.63

COLISTIN (COLISTIMETHATE NA) 150 MG INJ RECON.SOLN.

Facility

$133.92

Service Code	HCPCS J0770
Hospital Revenue Code	636
Min. Negotiated Rate	$11.39
Max. Negotiated Rate	$129.90
Rate for Payer: Cash Price	$87.05
Rate for Payer: Cash Price	$87.05
Rate for Payer: Hawaii Medical Service Association ABD	$11.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.39
Rate for Payer: Hawaii Western Management Group Commercial	$127.22
Rate for Payer: Health Management Network Commercial	$113.83
Rate for Payer: Kaiser Permanente Commercial	$84.37
Rate for Payer: Kaiser Permanente Medicaid	$68.30
Rate for Payer: MDX Hawaii PPO	$129.90
Rate for Payer: UnitedHealthcare Medicaid	$80.35
Rate for Payer: University Health Alliance Commercial	$97.61

COLISTIN (COLISTIMETHATE NA) 150 MG INJ RECON.SOLN.

Facility

$133.92

Service Code	HCPCS J0770
Hospital Revenue Code	250
Min. Negotiated Rate	$113.83
Max. Negotiated Rate	$129.90
Rate for Payer: Cash Price	$87.05
Rate for Payer: Health Management Network Commercial	$113.83
Rate for Payer: MDX Hawaii PPO	$129.90

COLLAGENASE 250 UNIT/G TOP OINT 30 G

Facility

$899.05

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$458.52
Max. Negotiated Rate	$872.08
Rate for Payer: Cash Price	$584.38
Rate for Payer: Hawaii Western Management Group Commercial	$854.10
Rate for Payer: Health Management Network Commercial	$764.19
Rate for Payer: Kaiser Permanente Commercial	$566.40
Rate for Payer: Kaiser Permanente Medicaid	$458.52
Rate for Payer: MDX Hawaii PPO	$872.08
Rate for Payer: UnitedHealthcare Medicaid	$539.43
Rate for Payer: University Health Alliance Commercial	$655.32

COLLAGENASE 250 UNIT/G TOP OINT 30 G

Facility

$899.05

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$764.19
Max. Negotiated Rate	$872.08
Rate for Payer: Cash Price	$584.38
Rate for Payer: Health Management Network Commercial	$764.19
Rate for Payer: MDX Hawaii PPO	$872.08

COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE

Professional

Both

$81.00

Service Code	HCPCS 36591
Min. Negotiated Rate	$31.55
Max. Negotiated Rate	$68.85
Rate for Payer: AlohaCare Medicaid	$31.55
Rate for Payer: AlohaCare Medicare	$34.37
Rate for Payer: Cash Price	$52.65
Rate for Payer: Cash Price	$52.65
Rate for Payer: Devoted Health Medicare	$37.81
Rate for Payer: Hawaii Medical Service Association Medicare	$34.37
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: Kaiser Permanente Commercial	$41.24
Rate for Payer: Kaiser Permanente Medicaid	$41.24
Rate for Payer: Kaiser Permanente Medicare	$41.24
Rate for Payer: Ohana Health Plan Medicaid	$31.55
Rate for Payer: Ohana Health Plan Medicare	$34.37
Rate for Payer: UnitedHealthcare Medicaid	$31.55
Rate for Payer: UnitedHealthcare Medicare	$34.37

COLLECTION OF BLOOD SPECIMEN FROM A COMPLETELY IMPLANTABLE VENOUS ACCESS DEVICE

Facility

$2,837.00

Service Code	CPT 36591
Hospital Revenue Code	361
Min. Negotiated Rate	$12.68
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association Commercial	$196.47
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicaid	$12.68
Rate for Payer: UnitedHealthcare Medicare	$157.18

COLLECTION VENOUS BLOOD VENIPUNCTURE

Professional

Both

$9.00

Service Code	HCPCS 36415
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$11.21
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$9.34
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cash Price	$5.85
Rate for Payer: Devoted Health Medicare	$10.27
Rate for Payer: Hawaii Medical Service Association Medicare	$9.34
Rate for Payer: Hawaii Western Management Group Commercial	$3.12
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$11.21
Rate for Payer: Kaiser Permanente Medicaid	$11.21
Rate for Payer: Kaiser Permanente Medicare	$11.21
Rate for Payer: Ohana Health Plan Medicaid	$3.00
Rate for Payer: Ohana Health Plan Medicare	$9.34
Rate for Payer: UnitedHealthcare Medicaid	$3.00
Rate for Payer: UnitedHealthcare Medicare	$9.34

COLONOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)

Facility

$6,183.00

Service Code	CPT 45378
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$1,098.60
Rate for Payer: AlohaCare Medicare	$1,098.60
Rate for Payer: Devoted Health Medicare	$1,208.46
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	$1,098.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$1,098.60
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,098.60
Rate for Payer: Ohana Health Plan Medicaid	$1,208.46
Rate for Payer: Ohana Health Plan Medicare	$1,098.60
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,098.60
Rate for Payer: University Health Alliance Commercial	$5,160.40

COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE

Facility

$6,183.00

Service Code	CPT 45380
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
Rate for Payer: University Health Alliance Commercial	$5,160.40

COLONOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING, ANY METHOD

Facility

$6,183.00

Service Code	CPT 45382
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
Rate for Payer: University Health Alliance Commercial	$5,160.40

COLONOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE

Facility

$6,183.00

Service Code	CPT 45381
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
Rate for Payer: University Health Alliance Commercial	$5,160.40

COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS

Facility

$6,183.00

Service Code	CPT 45384
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
Rate for Payer: University Health Alliance Commercial	$5,160.40

COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE

Facility

$6,183.00

Service Code	CPT 45385
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
Rate for Payer: University Health Alliance Commercial	$5,160.40

COLONOSCOPY THROUGH STOMA; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)

Facility

$2,837.00

Service Code	CPT 44388
Hospital Revenue Code	360
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$1,098.60
Rate for Payer: AlohaCare Medicare	$1,098.60
Rate for Payer: Devoted Health Medicare	$1,208.46
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,098.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Humana Medicare	$1,098.60
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,098.60
Rate for Payer: Ohana Health Plan Medicaid	$1,208.46
Rate for Payer: Ohana Health Plan Medicare	$1,098.60
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,098.60

Know your out-of-pocket cost for care.

All Charges