Kona Community Hospital

All Charges

Charge

Type

Setting

Price

CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH DOUBLE OSTEOTOMY, ANY METHOD

Facility

$11,157.19

Service Code	CPT 28299
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,157.19
Rate for Payer: AlohaCare Medicaid	$8,572.09
Rate for Payer: AlohaCare Medicare	$8,572.09
Rate for Payer: Devoted Health Medicare	$9,429.30
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$9,416.00
Rate for Payer: Hawaii Medical Service Association Medicare	$8,572.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Humana Medicare	$8,572.09
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$8,572.09
Rate for Payer: Ohana Health Plan Medicaid	$9,429.30
Rate for Payer: Ohana Health Plan Medicare	$8,572.09
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$8,572.09
Rate for Payer: University Health Alliance Commercial	$11,157.19

CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH FIRST METATARSAL AND MEDIAL CUNEIFORM JOINT ARTHRODESIS, ANY METHOD

Facility

$16,683.60

Service Code	CPT 28297
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$16,683.60
Rate for Payer: AlohaCare Medicaid	$15,166.91
Rate for Payer: AlohaCare Medicare	$15,166.91
Rate for Payer: Devoted Health Medicare	$16,683.60
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	$15,166.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$15,166.91
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$15,166.91
Rate for Payer: Ohana Health Plan Medicaid	$16,683.60
Rate for Payer: Ohana Health Plan Medicare	$15,166.91
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$15,166.91
Rate for Payer: University Health Alliance Commercial	$6,743.44

CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL FUSION, PARTIAL OR TOTAL PHALANGECTOMY)

Facility

$9,416.00

Service Code	CPT 28285
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$9,416.00
Rate for Payer: AlohaCare Medicaid	$3,865.36
Rate for Payer: AlohaCare Medicare	$3,865.36
Rate for Payer: Devoted Health Medicare	$4,251.90
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$9,416.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,865.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Humana Medicare	$3,865.36
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,865.36
Rate for Payer: Ohana Health Plan Medicaid	$4,251.90
Rate for Payer: Ohana Health Plan Medicare	$3,865.36
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,865.36
Rate for Payer: University Health Alliance Commercial	$6,743.44

CORRECTION OF MALROTATION BY LYSIS OF DUODENAL BANDS AND/OR REDUCTION OF MIDGUT VOLVULUS (EG, LADD PROCEDURE)

Facility

$2,837.00

Service Code	CPT 44055
Hospital Revenue Code	360
Min. Negotiated Rate	$775.86
Max. Negotiated Rate	$2,837.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$775.86

Cortical Screw, 2.7mm X 13mm AR-18827-13 [3645522]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3645522
Hospital Revenue Code	278
Min. Negotiated Rate	$610.98
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: Kaiser Permanente Commercial	$754.74
Rate for Payer: Kaiser Permanente Medicaid	$610.98
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Cortical Screw, 2.7mm X 13mm AR-18827-13 [3645522]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3645522
Hospital Revenue Code	278
Min. Negotiated Rate	$670.88
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Cortical Screw, 2.7mm X 15mm AR-18827-15 [3645555]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3645555
Hospital Revenue Code	278
Min. Negotiated Rate	$670.88
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Cortical Screw, 2.7mm X 15mm AR-18827-15 [3645555]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3645555
Hospital Revenue Code	278
Min. Negotiated Rate	$610.98
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: Kaiser Permanente Commercial	$754.74
Rate for Payer: Kaiser Permanente Medicaid	$610.98
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Cortical Screw, 2.7mm X 16mm AR-18827-16 [3645523]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3645523
Hospital Revenue Code	278
Min. Negotiated Rate	$610.98
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: Kaiser Permanente Commercial	$754.74
Rate for Payer: Kaiser Permanente Medicaid	$610.98
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Cortical Screw, 2.7mm X 16mm AR-18827-16 [3645523]

Facility

$1,198.00

Service Code	HCPCS C1713
Hospital Charge Code	3645523
Hospital Revenue Code	278
Min. Negotiated Rate	$670.88
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$838.60
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$670.88

Cortical Screw, Captured, 1.5mm X 95mm AR-9094-095 [3645536]

Facility

$6,725.00

Service Code	HCPCS C1713
Hospital Charge Code	3645536
Hospital Revenue Code	278
Min. Negotiated Rate	$3,766.00
Max. Negotiated Rate	$6,523.25
Rate for Payer: Cash Price	$4,371.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,707.50
Rate for Payer: Health Management Network Commercial	$5,716.25
Rate for Payer: MDX Hawaii PPO	$6,523.25
Rate for Payer: University Health Alliance Commercial	$3,766.00

Cortical Screw, Captured, 1.5mm X 95mm AR-9094-095 [3645536]

Facility

$6,725.00

Service Code	HCPCS C1713
Hospital Charge Code	3645536
Hospital Revenue Code	278
Min. Negotiated Rate	$3,429.75
Max. Negotiated Rate	$6,523.25
Rate for Payer: Cash Price	$4,371.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,707.50
Rate for Payer: Health Management Network Commercial	$5,716.25
Rate for Payer: Kaiser Permanente Commercial	$4,236.75
Rate for Payer: Kaiser Permanente Medicaid	$3,429.75
Rate for Payer: MDX Hawaii PPO	$6,523.25
Rate for Payer: University Health Alliance Commercial	$3,766.00

Cortical Screw, Captured, 5.0mm X 38mm AR-9093-50-038 [3645535]

Facility

$2,327.13

Service Code	HCPCS C1713
Hospital Charge Code	3645535
Hospital Revenue Code	278
Min. Negotiated Rate	$1,186.84
Max. Negotiated Rate	$2,257.32
Rate for Payer: Cash Price	$1,512.63
Rate for Payer: Hawaii Western Management Group Commercial	$1,628.99
Rate for Payer: Health Management Network Commercial	$1,978.06
Rate for Payer: Kaiser Permanente Commercial	$1,466.09
Rate for Payer: Kaiser Permanente Medicaid	$1,186.84
Rate for Payer: MDX Hawaii PPO	$2,257.32
Rate for Payer: University Health Alliance Commercial	$1,303.19

Cortical Screw, Captured, 5.0mm X 38mm AR-9093-50-038 [3645535]

Facility

$2,327.13

Service Code	HCPCS C1713
Hospital Charge Code	3645535
Hospital Revenue Code	278
Min. Negotiated Rate	$1,303.19
Max. Negotiated Rate	$2,257.32
Rate for Payer: Cash Price	$1,512.63
Rate for Payer: Hawaii Western Management Group Commercial	$1,628.99
Rate for Payer: Health Management Network Commercial	$1,978.06
Rate for Payer: MDX Hawaii PPO	$2,257.32
Rate for Payer: University Health Alliance Commercial	$1,303.19

CORTISOL TOTAL

Professional

Both

$32.00

Service Code	HCPCS 82533
Min. Negotiated Rate	$16.30
Max. Negotiated Rate	$27.20
Rate for Payer: AlohaCare Medicaid	$22.53
Rate for Payer: AlohaCare Medicare	$16.30
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Devoted Health Medicare	$17.93
Rate for Payer: Hawaii Medical Service Association Medicare	$16.30
Rate for Payer: Hawaii Western Management Group Commercial	$22.53
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: Kaiser Permanente Commercial	$19.56
Rate for Payer: Kaiser Permanente Medicaid	$19.56
Rate for Payer: Kaiser Permanente Medicare	$19.56
Rate for Payer: Ohana Health Plan Medicaid	$22.53
Rate for Payer: Ohana Health Plan Medicare	$16.30
Rate for Payer: UnitedHealthcare Medicaid	$22.53
Rate for Payer: UnitedHealthcare Medicare	$16.30

COSYNTROPIN 250 MCG INJ RECON SOLN

Facility

$432.21

Service Code	HCPCS J0834
Hospital Revenue Code	636
Min. Negotiated Rate	$28.02
Max. Negotiated Rate	$419.24
Rate for Payer: Cash Price	$280.94
Rate for Payer: Cash Price	$280.94
Rate for Payer: Cash Price	$299.83
Rate for Payer: Cash Price	$299.83
Rate for Payer: Hawaii Medical Service Association ABD	$28.02
Rate for Payer: Hawaii Medical Service Association ABD	$28.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.02
Rate for Payer: Hawaii Western Management Group Commercial	$410.60
Rate for Payer: Hawaii Western Management Group Commercial	$438.21
Rate for Payer: Health Management Network Commercial	$392.08
Rate for Payer: Health Management Network Commercial	$367.38
Rate for Payer: Kaiser Permanente Commercial	$290.60
Rate for Payer: Kaiser Permanente Commercial	$272.29
Rate for Payer: Kaiser Permanente Medicaid	$220.43
Rate for Payer: Kaiser Permanente Medicaid	$235.25
Rate for Payer: MDX Hawaii PPO	$447.43
Rate for Payer: MDX Hawaii PPO	$419.24
Rate for Payer: UnitedHealthcare Medicaid	$259.33
Rate for Payer: UnitedHealthcare Medicaid	$276.76
Rate for Payer: University Health Alliance Commercial	$336.22
Rate for Payer: University Health Alliance Commercial	$315.04

COSYNTROPIN 250 MCG INJ RECON SOLN

Facility

$432.21

Service Code	HCPCS J0834
Hospital Revenue Code	250
Min. Negotiated Rate	$367.38
Max. Negotiated Rate	$419.24
Rate for Payer: Cash Price	$280.94
Rate for Payer: Cash Price	$299.83
Rate for Payer: Health Management Network Commercial	$392.08
Rate for Payer: Health Management Network Commercial	$367.38
Rate for Payer: MDX Hawaii PPO	$447.43
Rate for Payer: MDX Hawaii PPO	$419.24

Cotton Wedge 6mm PCOT-181406 [3644932]

Facility

$8,433.00

Hospital Charge Code	3644932
Hospital Revenue Code	272
Min. Negotiated Rate	$4,300.83
Max. Negotiated Rate	$8,180.01
Rate for Payer: Cash Price	$5,481.45
Rate for Payer: Hawaii Western Management Group Commercial	$8,011.35
Rate for Payer: Health Management Network Commercial	$7,168.05
Rate for Payer: Kaiser Permanente Commercial	$5,312.79
Rate for Payer: Kaiser Permanente Medicaid	$4,300.83
Rate for Payer: MDX Hawaii PPO	$8,180.01
Rate for Payer: University Health Alliance Commercial	$6,146.81

Cotton Wedge 6mm PCOT-181406 [3644932]

Facility

$8,433.00

Hospital Charge Code	3644932
Hospital Revenue Code	272
Min. Negotiated Rate	$7,168.05
Max. Negotiated Rate	$8,180.01
Rate for Payer: Cash Price	$5,481.45
Rate for Payer: Health Management Network Commercial	$7,168.05
Rate for Payer: MDX Hawaii PPO	$8,180.01

Countersink 2.0 Headless P20-915-2000 [3644506]

Facility

$1,455.04

Hospital Charge Code	3644506
Hospital Revenue Code	272
Min. Negotiated Rate	$1,236.78
Max. Negotiated Rate	$1,411.39
Rate for Payer: Cash Price	$945.78
Rate for Payer: Health Management Network Commercial	$1,236.78
Rate for Payer: MDX Hawaii PPO	$1,411.39

Countersink 2.0 Headless P20-915-2000 [3644506]

Facility

$1,455.04

Hospital Charge Code	3644506
Hospital Revenue Code	272
Min. Negotiated Rate	$742.07
Max. Negotiated Rate	$1,411.39
Rate for Payer: Cash Price	$945.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,382.29
Rate for Payer: Health Management Network Commercial	$1,236.78
Rate for Payer: Kaiser Permanente Commercial	$916.68
Rate for Payer: Kaiser Permanente Medicaid	$742.07
Rate for Payer: MDX Hawaii PPO	$1,411.39
Rate for Payer: University Health Alliance Commercial	$1,060.58

Countersink 3.3mm Cannulated RHS-CSK-33 [3645378]

Facility

$4,305.50

Hospital Charge Code	3645378
Hospital Revenue Code	272
Min. Negotiated Rate	$2,195.80
Max. Negotiated Rate	$4,176.34
Rate for Payer: Cash Price	$2,798.58
Rate for Payer: Hawaii Western Management Group Commercial	$4,090.22
Rate for Payer: Health Management Network Commercial	$3,659.68
Rate for Payer: Kaiser Permanente Commercial	$2,712.47
Rate for Payer: Kaiser Permanente Medicaid	$2,195.80
Rate for Payer: MDX Hawaii PPO	$4,176.34
Rate for Payer: University Health Alliance Commercial	$3,138.28

Countersink 3.3mm Cannulated RHS-CSK-33 [3645378]

Facility

$4,305.50

Hospital Charge Code	3645378
Hospital Revenue Code	272
Min. Negotiated Rate	$3,659.68
Max. Negotiated Rate	$4,176.34
Rate for Payer: Cash Price	$2,798.58
Rate for Payer: Health Management Network Commercial	$3,659.68
Rate for Payer: MDX Hawaii PPO	$4,176.34

Countersink 4.0mm Headless P20-915-4000 [3644327]

Facility

$1,455.04

Hospital Charge Code	3644327
Hospital Revenue Code	272
Min. Negotiated Rate	$1,236.78
Max. Negotiated Rate	$1,411.39
Rate for Payer: Cash Price	$945.78
Rate for Payer: Health Management Network Commercial	$1,236.78
Rate for Payer: MDX Hawaii PPO	$1,411.39

Countersink 4.0mm Headless P20-915-4000 [3644327]

Facility

$1,455.04

Hospital Charge Code	3644327
Hospital Revenue Code	272
Min. Negotiated Rate	$742.07
Max. Negotiated Rate	$1,411.39
Rate for Payer: Cash Price	$945.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,382.29
Rate for Payer: Health Management Network Commercial	$1,236.78
Rate for Payer: Kaiser Permanente Commercial	$916.68
Rate for Payer: Kaiser Permanente Medicaid	$742.07
Rate for Payer: MDX Hawaii PPO	$1,411.39
Rate for Payer: University Health Alliance Commercial	$1,060.58

Know your out-of-pocket cost for care.

All Charges