Kona Community Hospital

All Charges

Charge

Type

Setting

Price

CONTINUOUS POSITIVE AIRWAY PRESSURE VENTILATION (CPAP), INITIATION AND MANAGEMENT

Facility

$2,837.00

Service Code	CPT 94660
Hospital Revenue Code	361
Min. Negotiated Rate	$39.67
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$258.69
Rate for Payer: AlohaCare Medicare	$258.69
Rate for Payer: Devoted Health Medicare	$284.56
Rate for Payer: Hawaii Medical Service Association Commercial	$323.36
Rate for Payer: Hawaii Medical Service Association Medicare	$258.69
Rate for Payer: Humana Medicare	$258.69
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$258.69
Rate for Payer: Ohana Health Plan Medicaid	$284.56
Rate for Payer: Ohana Health Plan Medicare	$258.69
Rate for Payer: UnitedHealthcare Medicaid	$39.67
Rate for Payer: UnitedHealthcare Medicare	$258.69

CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE

Facility

$10,458.31

Service Code	APR-DRG 3844
Min. Negotiated Rate	$10,458.31
Max. Negotiated Rate	$10,458.31
Rate for Payer: AlohaCare Medicaid	$10,458.31
Rate for Payer: Hawaii Medical Service Association ABD	$10,458.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,458.31
Rate for Payer: Kaiser Permanente Medicaid	$10,458.31
Rate for Payer: Ohana Health Plan Medicaid	$10,458.31
Rate for Payer: UnitedHealthcare Medicaid	$10,458.31

CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE

Facility

$5,674.77

Service Code	APR-DRG 3843
Min. Negotiated Rate	$5,674.77
Max. Negotiated Rate	$5,674.77
Rate for Payer: AlohaCare Medicaid	$5,674.77
Rate for Payer: Hawaii Medical Service Association ABD	$5,674.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,674.77
Rate for Payer: Kaiser Permanente Medicaid	$5,674.77
Rate for Payer: Ohana Health Plan Medicaid	$5,674.77
Rate for Payer: UnitedHealthcare Medicaid	$5,674.77

CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE

Facility

$3,849.82

Service Code	APR-DRG 3842
Min. Negotiated Rate	$3,849.82
Max. Negotiated Rate	$3,849.82
Rate for Payer: AlohaCare Medicaid	$3,849.82
Rate for Payer: Hawaii Medical Service Association ABD	$3,849.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,849.82
Rate for Payer: Kaiser Permanente Medicaid	$3,849.82
Rate for Payer: Ohana Health Plan Medicaid	$3,849.82
Rate for Payer: UnitedHealthcare Medicaid	$3,849.82

CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE

Facility

$2,945.40

Service Code	APR-DRG 3841
Min. Negotiated Rate	$2,945.40
Max. Negotiated Rate	$2,945.40
Rate for Payer: AlohaCare Medicaid	$2,945.40
Rate for Payer: Hawaii Medical Service Association ABD	$2,945.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,945.40
Rate for Payer: Kaiser Permanente Medicaid	$2,945.40
Rate for Payer: Ohana Health Plan Medicaid	$2,945.40
Rate for Payer: UnitedHealthcare Medicaid	$2,945.40

Cook Urethral Dilator Set Sterile Disp G14185 or 073701 [3642218]

Facility

$1,331.45

Hospital Charge Code	3642218
Hospital Revenue Code	272
Min. Negotiated Rate	$679.04
Max. Negotiated Rate	$1,291.51
Rate for Payer: Cash Price	$865.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,264.88
Rate for Payer: Health Management Network Commercial	$1,131.73
Rate for Payer: Kaiser Permanente Commercial	$838.81
Rate for Payer: Kaiser Permanente Medicaid	$679.04
Rate for Payer: MDX Hawaii PPO	$1,291.51
Rate for Payer: University Health Alliance Commercial	$970.49

Cook Urethral Dilator Set Sterile Disp G14185 or 073701 [3642218]

Facility

$1,331.45

Hospital Charge Code	3642218
Hospital Revenue Code	272
Min. Negotiated Rate	$1,131.73
Max. Negotiated Rate	$1,291.51
Rate for Payer: Cash Price	$865.44
Rate for Payer: Health Management Network Commercial	$1,131.73
Rate for Payer: MDX Hawaii PPO	$1,291.51

COPPER CU-64 DOTATATE DIAGNOSTIC 1 MCI

Professional

Both

$3,000.00

Service Code	HCPCS A9592
Min. Negotiated Rate	$2,550.00
Max. Negotiated Rate	$2,550.00
Rate for Payer: Cash Price	$1,950.00
Rate for Payer: Health Management Network Commercial	$2,550.00

CORONARY BYPASS W AMI OR COMPLEX PDX

Facility

$27,665.27

Service Code	APR-DRG 1653
Min. Negotiated Rate	$27,665.27
Max. Negotiated Rate	$27,665.27
Rate for Payer: AlohaCare Medicaid	$27,665.27
Rate for Payer: Hawaii Medical Service Association ABD	$27,665.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27,665.27
Rate for Payer: Kaiser Permanente Medicaid	$27,665.27
Rate for Payer: Ohana Health Plan Medicaid	$27,665.27
Rate for Payer: UnitedHealthcare Medicaid	$27,665.27

CORONARY BYPASS W AMI OR COMPLEX PDX

Facility

$22,682.29

Service Code	APR-DRG 1652
Min. Negotiated Rate	$22,682.29
Max. Negotiated Rate	$22,682.29
Rate for Payer: AlohaCare Medicaid	$22,682.29
Rate for Payer: Hawaii Medical Service Association ABD	$22,682.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22,682.29
Rate for Payer: Kaiser Permanente Medicaid	$22,682.29
Rate for Payer: Ohana Health Plan Medicaid	$22,682.29
Rate for Payer: UnitedHealthcare Medicaid	$22,682.29

CORONARY BYPASS W AMI OR COMPLEX PDX

Facility

$37,463.12

Service Code	APR-DRG 1654
Min. Negotiated Rate	$37,463.12
Max. Negotiated Rate	$37,463.12
Rate for Payer: AlohaCare Medicaid	$37,463.12
Rate for Payer: Hawaii Medical Service Association ABD	$37,463.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$37,463.12
Rate for Payer: Kaiser Permanente Medicaid	$37,463.12
Rate for Payer: Ohana Health Plan Medicaid	$37,463.12
Rate for Payer: UnitedHealthcare Medicaid	$37,463.12

CORONARY BYPASS W AMI OR COMPLEX PDX

Facility

$19,423.13

Service Code	APR-DRG 1651
Min. Negotiated Rate	$19,423.13
Max. Negotiated Rate	$19,423.13
Rate for Payer: AlohaCare Medicaid	$19,423.13
Rate for Payer: Hawaii Medical Service Association ABD	$19,423.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19,423.13
Rate for Payer: Kaiser Permanente Medicaid	$19,423.13
Rate for Payer: Ohana Health Plan Medicaid	$19,423.13
Rate for Payer: UnitedHealthcare Medicaid	$19,423.13

CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC

Facility

$131,879.70

Service Code	MSDRG 233
Min. Negotiated Rate	$100,555.53
Max. Negotiated Rate	$131,879.70
Rate for Payer: AlohaCare Medicare	$100,555.53
Rate for Payer: Devoted Health Medicare	$110,611.08
Rate for Payer: Hawaii Medical Service Association Commercial	$129,502.80
Rate for Payer: Hawaii Medical Service Association Medicare	$100,555.53
Rate for Payer: Humana Medicare	$100,555.53
Rate for Payer: Kaiser Permanente Commercial	$131,879.70
Rate for Payer: Kaiser Permanente Medicare	$100,555.53
Rate for Payer: Ohana Health Plan Medicare	$100,555.53
Rate for Payer: UnitedHealthcare Medicare	$100,555.53

CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC

Facility

$113,664.51

Service Code	MSDRG 234
Min. Negotiated Rate	$71,849.62
Max. Negotiated Rate	$113,664.51
Rate for Payer: AlohaCare Medicare	$71,849.62
Rate for Payer: Devoted Health Medicare	$79,034.58
Rate for Payer: Hawaii Medical Service Association Commercial	$113,664.51
Rate for Payer: Hawaii Medical Service Association Medicare	$71,849.62
Rate for Payer: Humana Medicare	$71,849.62
Rate for Payer: Kaiser Permanente Commercial	$94,231.57
Rate for Payer: Kaiser Permanente Medicare	$71,849.62
Rate for Payer: Ohana Health Plan Medicare	$71,849.62
Rate for Payer: UnitedHealthcare Medicare	$71,849.62

CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$101,233.35

Service Code	MSDRG 235
Min. Negotiated Rate	$77,188.31
Max. Negotiated Rate	$101,233.35
Rate for Payer: AlohaCare Medicare	$77,188.31
Rate for Payer: Devoted Health Medicare	$84,907.14
Rate for Payer: Hawaii Medical Service Association Commercial	$98,862.81
Rate for Payer: Hawaii Medical Service Association Medicare	$77,188.31
Rate for Payer: Humana Medicare	$77,188.31
Rate for Payer: Kaiser Permanente Commercial	$101,233.35
Rate for Payer: Kaiser Permanente Medicare	$77,188.31
Rate for Payer: Ohana Health Plan Medicare	$77,188.31
Rate for Payer: UnitedHealthcare Medicare	$77,188.31

CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$91,919.99

Service Code	MSDRG 236
Min. Negotiated Rate	$55,094.31
Max. Negotiated Rate	$91,919.99
Rate for Payer: AlohaCare Medicare	$55,094.31
Rate for Payer: Devoted Health Medicare	$60,603.74
Rate for Payer: Hawaii Medical Service Association Commercial	$91,919.99
Rate for Payer: Hawaii Medical Service Association Medicare	$55,094.31
Rate for Payer: Humana Medicare	$55,094.31
Rate for Payer: Kaiser Permanente Commercial	$72,256.80
Rate for Payer: Kaiser Permanente Medicare	$55,094.31
Rate for Payer: Ohana Health Plan Medicare	$55,094.31
Rate for Payer: UnitedHealthcare Medicare	$55,094.31

CORONARY BYPASS WITH PTCA WITH MCC

Facility

$145,415.77

Service Code	MSDRG 231
Min. Negotiated Rate	$110,876.50
Max. Negotiated Rate	$145,415.77
Rate for Payer: AlohaCare Medicare	$110,876.50
Rate for Payer: Devoted Health Medicare	$121,964.15
Rate for Payer: Hawaii Medical Service Association Commercial	$142,906.30
Rate for Payer: Hawaii Medical Service Association Medicare	$110,876.50
Rate for Payer: Humana Medicare	$110,876.50
Rate for Payer: Kaiser Permanente Commercial	$145,415.77
Rate for Payer: Kaiser Permanente Medicare	$110,876.50
Rate for Payer: Ohana Health Plan Medicare	$110,876.50
Rate for Payer: UnitedHealthcare Medicare	$110,876.50

CORONARY BYPASS WITH PTCA WITHOUT MCC

Facility

$142,906.30

Service Code	MSDRG 232
Min. Negotiated Rate	$79,739.96
Max. Negotiated Rate	$142,906.30
Rate for Payer: AlohaCare Medicare	$79,739.96
Rate for Payer: Devoted Health Medicare	$87,713.96
Rate for Payer: Hawaii Medical Service Association Commercial	$142,906.30
Rate for Payer: Hawaii Medical Service Association Medicare	$79,739.96
Rate for Payer: Humana Medicare	$79,739.96
Rate for Payer: Kaiser Permanente Commercial	$104,579.85
Rate for Payer: Kaiser Permanente Medicare	$79,739.96
Rate for Payer: Ohana Health Plan Medicare	$79,739.96
Rate for Payer: UnitedHealthcare Medicare	$79,739.96

CORONARY BYPASS W/O AMI OR COMPLEX PDX

Facility

$22,605.23

Service Code	APR-DRG 1663
Min. Negotiated Rate	$22,605.23
Max. Negotiated Rate	$22,605.23
Rate for Payer: AlohaCare Medicaid	$22,605.23
Rate for Payer: Hawaii Medical Service Association ABD	$22,605.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22,605.23
Rate for Payer: Kaiser Permanente Medicaid	$22,605.23
Rate for Payer: Ohana Health Plan Medicaid	$22,605.23
Rate for Payer: UnitedHealthcare Medicaid	$22,605.23

CORONARY BYPASS W/O AMI OR COMPLEX PDX

Facility

$33,529.59

Service Code	APR-DRG 1664
Min. Negotiated Rate	$33,529.59
Max. Negotiated Rate	$33,529.59
Rate for Payer: AlohaCare Medicaid	$33,529.59
Rate for Payer: Hawaii Medical Service Association ABD	$33,529.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$33,529.59
Rate for Payer: Kaiser Permanente Medicaid	$33,529.59
Rate for Payer: Ohana Health Plan Medicaid	$33,529.59
Rate for Payer: UnitedHealthcare Medicaid	$33,529.59

CORONARY BYPASS W/O AMI OR COMPLEX PDX

Facility

$19,009.21

Service Code	APR-DRG 1662
Min. Negotiated Rate	$19,009.21
Max. Negotiated Rate	$19,009.21
Rate for Payer: AlohaCare Medicaid	$19,009.21
Rate for Payer: Hawaii Medical Service Association ABD	$19,009.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19,009.21
Rate for Payer: Kaiser Permanente Medicaid	$19,009.21
Rate for Payer: Ohana Health Plan Medicaid	$19,009.21
Rate for Payer: UnitedHealthcare Medicaid	$19,009.21

CORONARY BYPASS W/O AMI OR COMPLEX PDX

Facility

$17,286.65

Service Code	APR-DRG 1661
Min. Negotiated Rate	$17,286.65
Max. Negotiated Rate	$17,286.65
Rate for Payer: AlohaCare Medicaid	$17,286.65
Rate for Payer: Hawaii Medical Service Association ABD	$17,286.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17,286.65
Rate for Payer: Kaiser Permanente Medicaid	$17,286.65
Rate for Payer: Ohana Health Plan Medicaid	$17,286.65
Rate for Payer: UnitedHealthcare Medicaid	$17,286.65

CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC

Facility

$74,647.65

Service Code	MSDRG 323
Min. Negotiated Rate	$41,174.76
Max. Negotiated Rate	$74,647.65
Rate for Payer: AlohaCare Medicare	$56,917.28
Rate for Payer: Devoted Health Medicare	$62,609.01
Rate for Payer: Hawaii Medical Service Association Commercial	$41,174.76
Rate for Payer: Hawaii Medical Service Association Medicare	$56,917.28
Rate for Payer: Humana Medicare	$56,917.28
Rate for Payer: Kaiser Permanente Commercial	$74,647.65
Rate for Payer: Kaiser Permanente Medicare	$56,917.28
Rate for Payer: Ohana Health Plan Medicare	$56,917.28
Rate for Payer: UnitedHealthcare Medicare	$56,917.28

CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility

$54,354.75

Service Code	MSDRG 324
Min. Negotiated Rate	$41,174.76
Max. Negotiated Rate	$54,354.75
Rate for Payer: AlohaCare Medicare	$41,444.36
Rate for Payer: Devoted Health Medicare	$45,588.80
Rate for Payer: Hawaii Medical Service Association Commercial	$41,174.76
Rate for Payer: Hawaii Medical Service Association Medicare	$41,444.36
Rate for Payer: Humana Medicare	$41,444.36
Rate for Payer: Kaiser Permanente Commercial	$54,354.75
Rate for Payer: Kaiser Permanente Medicare	$41,444.36
Rate for Payer: Ohana Health Plan Medicare	$41,444.36
Rate for Payer: UnitedHealthcare Medicare	$41,444.36

CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE

Facility

$55,379.40

Service Code	MSDRG 325
Min. Negotiated Rate	$38,764.06
Max. Negotiated Rate	$55,379.40
Rate for Payer: AlohaCare Medicare	$42,225.63
Rate for Payer: Devoted Health Medicare	$46,448.19
Rate for Payer: Hawaii Medical Service Association Commercial	$38,764.06
Rate for Payer: Hawaii Medical Service Association Medicare	$42,225.63
Rate for Payer: Humana Medicare	$42,225.63
Rate for Payer: Kaiser Permanente Commercial	$55,379.40
Rate for Payer: Kaiser Permanente Medicare	$42,225.63
Rate for Payer: Ohana Health Plan Medicare	$42,225.63
Rate for Payer: UnitedHealthcare Medicare	$42,225.63

Know your out-of-pocket cost for care.

All Charges