Kona Community Hospital

All Charges

Charge

Type

Setting

Price

CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA

Facility

$5,446.58

Service Code	APR-DRG 0573
Min. Negotiated Rate	$5,446.58
Max. Negotiated Rate	$5,446.58
Rate for Payer: AlohaCare Medicaid	$5,446.58
Rate for Payer: Hawaii Medical Service Association ABD	$5,446.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,446.58
Rate for Payer: Kaiser Permanente Medicaid	$5,446.58
Rate for Payer: Ohana Health Plan Medicaid	$5,446.58
Rate for Payer: UnitedHealthcare Medicaid	$5,446.58

CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA

Facility

$3,811.90

Service Code	APR-DRG 0572
Min. Negotiated Rate	$3,811.90
Max. Negotiated Rate	$3,811.90
Rate for Payer: AlohaCare Medicaid	$3,811.90
Rate for Payer: Hawaii Medical Service Association ABD	$3,811.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,811.90
Rate for Payer: Kaiser Permanente Medicaid	$3,811.90
Rate for Payer: Ohana Health Plan Medicaid	$3,811.90
Rate for Payer: UnitedHealthcare Medicaid	$3,811.90

CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA

Facility

$2,472.71

Service Code	APR-DRG 0571
Min. Negotiated Rate	$2,472.71
Max. Negotiated Rate	$2,472.71
Rate for Payer: AlohaCare Medicaid	$2,472.71
Rate for Payer: Hawaii Medical Service Association ABD	$2,472.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,472.71
Rate for Payer: Kaiser Permanente Medicaid	$2,472.71
Rate for Payer: Ohana Health Plan Medicaid	$2,472.71
Rate for Payer: UnitedHealthcare Medicaid	$2,472.71

CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA

Facility

$9,413.22

Service Code	APR-DRG 0574
Min. Negotiated Rate	$9,413.22
Max. Negotiated Rate	$9,413.22
Rate for Payer: AlohaCare Medicaid	$9,413.22
Rate for Payer: Hawaii Medical Service Association ABD	$9,413.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,413.22
Rate for Payer: Kaiser Permanente Medicaid	$9,413.22
Rate for Payer: Ohana Health Plan Medicaid	$9,413.22
Rate for Payer: UnitedHealthcare Medicaid	$9,413.22

CONCUSSION WITH CC

Facility

$22,877.54

Service Code	MSDRG 089
Min. Negotiated Rate	$14,449.62
Max. Negotiated Rate	$22,877.54
Rate for Payer: AlohaCare Medicare	$14,449.62
Rate for Payer: Devoted Health Medicare	$15,894.58
Rate for Payer: Hawaii Medical Service Association Commercial	$22,877.54
Rate for Payer: Hawaii Medical Service Association Medicare	$14,449.62
Rate for Payer: Humana Medicare	$14,449.62
Rate for Payer: Kaiser Permanente Commercial	$18,950.85
Rate for Payer: Kaiser Permanente Medicare	$14,449.62
Rate for Payer: Ohana Health Plan Medicare	$14,449.62
Rate for Payer: UnitedHealthcare Medicare	$14,449.62

CONCUSSION WITH MCC

Facility

$23,318.55

Service Code	MSDRG 088
Min. Negotiated Rate	$17,779.90
Max. Negotiated Rate	$23,318.55
Rate for Payer: AlohaCare Medicare	$17,779.90
Rate for Payer: Devoted Health Medicare	$19,557.89
Rate for Payer: Hawaii Medical Service Association Commercial	$22,877.54
Rate for Payer: Hawaii Medical Service Association Medicare	$17,779.90
Rate for Payer: Humana Medicare	$17,779.90
Rate for Payer: Kaiser Permanente Commercial	$23,318.55
Rate for Payer: Kaiser Permanente Medicare	$17,779.90
Rate for Payer: Ohana Health Plan Medicare	$17,779.90
Rate for Payer: UnitedHealthcare Medicare	$17,779.90

CONCUSSION WITHOUT CC/MCC

Facility

$17,067.76

Service Code	MSDRG 090
Min. Negotiated Rate	$10,827.37
Max. Negotiated Rate	$17,067.76
Rate for Payer: AlohaCare Medicare	$10,827.37
Rate for Payer: Devoted Health Medicare	$11,910.11
Rate for Payer: Hawaii Medical Service Association Commercial	$17,067.76
Rate for Payer: Hawaii Medical Service Association Medicare	$10,827.37
Rate for Payer: Humana Medicare	$10,827.37
Rate for Payer: Kaiser Permanente Commercial	$14,200.20
Rate for Payer: Kaiser Permanente Medicare	$10,827.37
Rate for Payer: Ohana Health Plan Medicare	$10,827.37
Rate for Payer: UnitedHealthcare Medicare	$10,827.37

Conical Extraction Device For Thrd Washer [3643628]

Facility

$824.12

Hospital Charge Code	3643628
Hospital Revenue Code	272
Min. Negotiated Rate	$700.50
Max. Negotiated Rate	$799.40
Rate for Payer: Cash Price	$535.68
Rate for Payer: Health Management Network Commercial	$700.50
Rate for Payer: MDX Hawaii PPO	$799.40

Conical Extraction Device For Thrd Washer [3643628]

Facility

$824.12

Hospital Charge Code	3643628
Hospital Revenue Code	272
Min. Negotiated Rate	$420.30
Max. Negotiated Rate	$799.40
Rate for Payer: Cash Price	$535.68
Rate for Payer: Hawaii Western Management Group Commercial	$782.91
Rate for Payer: Health Management Network Commercial	$700.50
Rate for Payer: Kaiser Permanente Commercial	$519.20
Rate for Payer: Kaiser Permanente Medicaid	$420.30
Rate for Payer: MDX Hawaii PPO	$799.40
Rate for Payer: University Health Alliance Commercial	$600.70

Conical Extraction Screw For 1.5/2.0mm Screw 309.510 [3644969]

Facility

$1,063.59

Hospital Charge Code	3644969
Hospital Revenue Code	272
Min. Negotiated Rate	$542.43
Max. Negotiated Rate	$1,031.68
Rate for Payer: Cash Price	$691.33
Rate for Payer: Hawaii Western Management Group Commercial	$1,010.41
Rate for Payer: Health Management Network Commercial	$904.05
Rate for Payer: Kaiser Permanente Commercial	$670.06
Rate for Payer: Kaiser Permanente Medicaid	$542.43
Rate for Payer: MDX Hawaii PPO	$1,031.68
Rate for Payer: University Health Alliance Commercial	$775.25

Conical Extraction Screw For 1.5/2.0mm Screw 309.510 [3644969]

Facility

$1,063.59

Hospital Charge Code	3644969
Hospital Revenue Code	272
Min. Negotiated Rate	$904.05
Max. Negotiated Rate	$1,031.68
Rate for Payer: Cash Price	$691.33
Rate for Payer: Health Management Network Commercial	$904.05
Rate for Payer: MDX Hawaii PPO	$1,031.68

Conical Extraction Screw For 2.7/3.5mm Screw [3623778]

Facility

$388.31

Service Code	HCPCS C1713
Hospital Charge Code	3623778
Hospital Revenue Code	278
Min. Negotiated Rate	$198.04
Max. Negotiated Rate	$376.66
Rate for Payer: Cash Price	$252.40
Rate for Payer: Hawaii Western Management Group Commercial	$271.82
Rate for Payer: Health Management Network Commercial	$330.06
Rate for Payer: Kaiser Permanente Commercial	$244.64
Rate for Payer: Kaiser Permanente Medicaid	$198.04
Rate for Payer: MDX Hawaii PPO	$376.66
Rate for Payer: University Health Alliance Commercial	$217.45

Conical Extraction Screw For 2.7/3.5mm Screw [3623778]

Facility

$388.31

Service Code	HCPCS C1713
Hospital Charge Code	3623778
Hospital Revenue Code	278
Min. Negotiated Rate	$217.45
Max. Negotiated Rate	$376.66
Rate for Payer: Cash Price	$252.40
Rate for Payer: Hawaii Western Management Group Commercial	$271.82
Rate for Payer: Health Management Network Commercial	$330.06
Rate for Payer: MDX Hawaii PPO	$376.66
Rate for Payer: University Health Alliance Commercial	$217.45

Conical Extraction Screw for 7.3mm Cann Screw 387.34 [3642881]

Facility

$2,516.75

Service Code	HCPCS C1713
Hospital Charge Code	3642881
Hospital Revenue Code	278
Min. Negotiated Rate	$1,283.54
Max. Negotiated Rate	$2,441.25
Rate for Payer: Cash Price	$1,635.89
Rate for Payer: Hawaii Western Management Group Commercial	$1,761.72
Rate for Payer: Health Management Network Commercial	$2,139.24
Rate for Payer: Kaiser Permanente Commercial	$1,585.55
Rate for Payer: Kaiser Permanente Medicaid	$1,283.54
Rate for Payer: MDX Hawaii PPO	$2,441.25
Rate for Payer: University Health Alliance Commercial	$1,409.38

Conical Extraction Screw for 7.3mm Cann Screw 387.34 [3642881]

Facility

$2,516.75

Service Code	HCPCS C1713
Hospital Charge Code	3642881
Hospital Revenue Code	278
Min. Negotiated Rate	$1,409.38
Max. Negotiated Rate	$2,441.25
Rate for Payer: Cash Price	$1,635.89
Rate for Payer: Hawaii Western Management Group Commercial	$1,761.72
Rate for Payer: Health Management Network Commercial	$2,139.24
Rate for Payer: MDX Hawaii PPO	$2,441.25
Rate for Payer: University Health Alliance Commercial	$1,409.38

CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; LOOP ELECTRODE EXCISION

Facility

$6,183.00

Service Code	CPT 57522
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$3,824.16
Rate for Payer: AlohaCare Medicare	$3,824.16
Rate for Payer: Devoted Health Medicare	$4,206.58
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	$3,824.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,824.16
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,824.16
Rate for Payer: Ohana Health Plan Medicaid	$4,206.58
Rate for Payer: Ohana Health Plan Medicare	$3,824.16
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,824.16
Rate for Payer: University Health Alliance Commercial	$5,160.40

CONJUGATED ESTROGENS 25 MG INJ RECON.SOLN.

Facility

$1,022.41

Service Code	HCPCS J1410
Hospital Revenue Code	636
Min. Negotiated Rate	$390.74
Max. Negotiated Rate	$991.74
Rate for Payer: AlohaCare Medicaid	$391.72
Rate for Payer: AlohaCare Medicare	$391.72
Rate for Payer: Cash Price	$664.57
Rate for Payer: Cash Price	$664.57
Rate for Payer: Devoted Health Medicare	$430.89
Rate for Payer: Hawaii Medical Service Association ABD	$390.74
Rate for Payer: Hawaii Medical Service Association Commercial	$489.65
Rate for Payer: Hawaii Medical Service Association Medicare	$391.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$390.74
Rate for Payer: Hawaii Western Management Group Commercial	$971.29
Rate for Payer: Health Management Network Commercial	$869.05
Rate for Payer: Humana Medicare	$391.72
Rate for Payer: Kaiser Permanente Commercial	$644.12
Rate for Payer: Kaiser Permanente Medicaid	$521.43
Rate for Payer: Kaiser Permanente Medicare	$391.72
Rate for Payer: MDX Hawaii PPO	$991.74
Rate for Payer: Ohana Health Plan Medicaid	$430.89
Rate for Payer: Ohana Health Plan Medicare	$391.72
Rate for Payer: UnitedHealthcare Medicaid	$613.45
Rate for Payer: UnitedHealthcare Medicare	$391.72
Rate for Payer: University Health Alliance Commercial	$745.23

CONJUGATED ESTROGENS 25 MG INJ RECON.SOLN.

Facility

$1,022.41

Service Code	HCPCS J1410
Hospital Revenue Code	250
Min. Negotiated Rate	$869.05
Max. Negotiated Rate	$991.74
Rate for Payer: Cash Price	$664.57
Rate for Payer: Health Management Network Commercial	$869.05
Rate for Payer: MDX Hawaii PPO	$991.74

CONNECTIVE TISSUE DISORDERS

Facility

$6,547.61

Service Code	APR-DRG 3463
Min. Negotiated Rate	$6,547.61
Max. Negotiated Rate	$6,547.61
Rate for Payer: AlohaCare Medicaid	$6,547.61
Rate for Payer: Hawaii Medical Service Association ABD	$6,547.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,547.61
Rate for Payer: Kaiser Permanente Medicaid	$6,547.61
Rate for Payer: Ohana Health Plan Medicaid	$6,547.61
Rate for Payer: UnitedHealthcare Medicaid	$6,547.61

CONNECTIVE TISSUE DISORDERS

Facility

$13,367.77

Service Code	APR-DRG 3464
Min. Negotiated Rate	$13,367.77
Max. Negotiated Rate	$13,367.77
Rate for Payer: AlohaCare Medicaid	$13,367.77
Rate for Payer: Hawaii Medical Service Association ABD	$13,367.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,367.77
Rate for Payer: Kaiser Permanente Medicaid	$13,367.77
Rate for Payer: Ohana Health Plan Medicaid	$13,367.77
Rate for Payer: UnitedHealthcare Medicaid	$13,367.77

CONNECTIVE TISSUE DISORDERS

Facility

$3,287.18

Service Code	APR-DRG 3461
Min. Negotiated Rate	$3,287.18
Max. Negotiated Rate	$3,287.18
Rate for Payer: AlohaCare Medicaid	$3,287.18
Rate for Payer: Hawaii Medical Service Association ABD	$3,287.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,287.18
Rate for Payer: Kaiser Permanente Medicaid	$3,287.18
Rate for Payer: Ohana Health Plan Medicaid	$3,287.18
Rate for Payer: UnitedHealthcare Medicaid	$3,287.18

CONNECTIVE TISSUE DISORDERS

Facility

$4,353.19

Service Code	APR-DRG 3462
Min. Negotiated Rate	$4,353.19
Max. Negotiated Rate	$4,353.19
Rate for Payer: AlohaCare Medicaid	$4,353.19
Rate for Payer: Hawaii Medical Service Association ABD	$4,353.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,353.19
Rate for Payer: Kaiser Permanente Medicaid	$4,353.19
Rate for Payer: Ohana Health Plan Medicaid	$4,353.19
Rate for Payer: UnitedHealthcare Medicaid	$4,353.19

CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$35,244.43

Service Code	MSDRG 546
Min. Negotiated Rate	$15,170.40
Max. Negotiated Rate	$35,244.43
Rate for Payer: AlohaCare Medicare	$15,170.40
Rate for Payer: Devoted Health Medicare	$16,687.44
Rate for Payer: Hawaii Medical Service Association Commercial	$35,244.43
Rate for Payer: Hawaii Medical Service Association Medicare	$15,170.40
Rate for Payer: Humana Medicare	$15,170.40
Rate for Payer: Kaiser Permanente Commercial	$19,896.15
Rate for Payer: Kaiser Permanente Medicare	$15,170.40
Rate for Payer: Ohana Health Plan Medicare	$15,170.40
Rate for Payer: UnitedHealthcare Medicare	$15,170.40

CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$42,809.32

Service Code	MSDRG 545
Min. Negotiated Rate	$32,641.22
Max. Negotiated Rate	$42,809.32
Rate for Payer: AlohaCare Medicare	$32,641.22
Rate for Payer: Devoted Health Medicare	$35,905.34
Rate for Payer: Hawaii Medical Service Association Commercial	$40,716.72
Rate for Payer: Hawaii Medical Service Association Medicare	$32,641.22
Rate for Payer: Humana Medicare	$32,641.22
Rate for Payer: Kaiser Permanente Commercial	$42,809.32
Rate for Payer: Kaiser Permanente Medicare	$32,641.22
Rate for Payer: Ohana Health Plan Medicare	$32,641.22
Rate for Payer: UnitedHealthcare Medicare	$32,641.22

CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$29,796.25

Service Code	MSDRG 547
Min. Negotiated Rate	$10,998.34
Max. Negotiated Rate	$29,796.25
Rate for Payer: AlohaCare Medicare	$10,998.34
Rate for Payer: Devoted Health Medicare	$12,098.17
Rate for Payer: Hawaii Medical Service Association Commercial	$29,796.25
Rate for Payer: Hawaii Medical Service Association Medicare	$10,998.34
Rate for Payer: Humana Medicare	$10,998.34
Rate for Payer: Kaiser Permanente Commercial	$14,424.45
Rate for Payer: Kaiser Permanente Medicare	$10,998.34
Rate for Payer: Ohana Health Plan Medicare	$10,998.34
Rate for Payer: UnitedHealthcare Medicare	$10,998.34

Know your out-of-pocket cost for care.

All Charges