Kona Community Hospital

All Charges

Charge

Type

Setting

Price

EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA

Facility

$16,575.41

Service Code	APR-DRG 9113
Min. Negotiated Rate	$16,575.41
Max. Negotiated Rate	$16,575.41
Rate for Payer: AlohaCare Medicaid	$16,575.41
Rate for Payer: Hawaii Medical Service Association ABD	$16,575.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16,575.41
Rate for Payer: Kaiser Permanente Medicaid	$16,575.41
Rate for Payer: Ohana Health Plan Medicaid	$16,575.41
Rate for Payer: UnitedHealthcare Medicaid	$16,575.41

EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT

Facility

$65,838.07

Service Code	MSDRG 933
Min. Negotiated Rate	$51,219.50
Max. Negotiated Rate	$65,838.07
Rate for Payer: AlohaCare Medicare	$51,219.50
Rate for Payer: Devoted Health Medicare	$56,341.45
Rate for Payer: Hawaii Medical Service Association Commercial	$62,678.20
Rate for Payer: Hawaii Medical Service Association Medicare	$51,219.50
Rate for Payer: Humana Medicare	$51,219.50
Rate for Payer: Kaiser Permanente Commercial	$65,838.07
Rate for Payer: Kaiser Permanente Medicare	$51,219.50
Rate for Payer: Ohana Health Plan Medicare	$51,219.50
Rate for Payer: UnitedHealthcare Medicare	$51,219.50

EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT

Facility

$389,038.77

Service Code	MSDRG 927
Min. Negotiated Rate	$280,818.13
Max. Negotiated Rate	$389,038.77
Rate for Payer: AlohaCare Medicare	$280,818.13
Rate for Payer: Devoted Health Medicare	$308,899.94
Rate for Payer: Hawaii Medical Service Association Commercial	$389,038.77
Rate for Payer: Hawaii Medical Service Association Medicare	$280,818.13
Rate for Payer: Humana Medicare	$280,818.13
Rate for Payer: Kaiser Permanente Commercial	$317,920.95
Rate for Payer: Kaiser Permanente Medicare	$280,818.13
Rate for Payer: Ohana Health Plan Medicare	$280,818.13
Rate for Payer: UnitedHealthcare Medicare	$280,818.13

EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$7,584.32

Service Code	APR-DRG 7921
Min. Negotiated Rate	$7,584.32
Max. Negotiated Rate	$7,584.32
Rate for Payer: AlohaCare Medicaid	$7,584.32
Rate for Payer: Hawaii Medical Service Association ABD	$7,584.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,584.32
Rate for Payer: Kaiser Permanente Medicaid	$7,584.32
Rate for Payer: Ohana Health Plan Medicaid	$7,584.32
Rate for Payer: UnitedHealthcare Medicaid	$7,584.32

EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$8,906.96

Service Code	APR-DRG 7922
Min. Negotiated Rate	$8,906.96
Max. Negotiated Rate	$8,906.96
Rate for Payer: AlohaCare Medicaid	$8,906.96
Rate for Payer: Hawaii Medical Service Association ABD	$8,906.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,906.96
Rate for Payer: Kaiser Permanente Medicaid	$8,906.96
Rate for Payer: Ohana Health Plan Medicaid	$8,906.96
Rate for Payer: UnitedHealthcare Medicaid	$8,906.96

EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$13,093.31

Service Code	APR-DRG 7923
Min. Negotiated Rate	$13,093.31
Max. Negotiated Rate	$13,093.31
Rate for Payer: AlohaCare Medicaid	$13,093.31
Rate for Payer: Hawaii Medical Service Association ABD	$13,093.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,093.31
Rate for Payer: Kaiser Permanente Medicaid	$13,093.31
Rate for Payer: Ohana Health Plan Medicaid	$13,093.31
Rate for Payer: UnitedHealthcare Medicaid	$13,093.31

EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$25,443.46

Service Code	APR-DRG 7924
Min. Negotiated Rate	$25,443.46
Max. Negotiated Rate	$25,443.46
Rate for Payer: AlohaCare Medicaid	$25,443.46
Rate for Payer: Hawaii Medical Service Association ABD	$25,443.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$25,443.46
Rate for Payer: Kaiser Permanente Medicaid	$25,443.46
Rate for Payer: Ohana Health Plan Medicaid	$25,443.46
Rate for Payer: UnitedHealthcare Medicaid	$25,443.46

EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$46,430.08

Service Code	MSDRG 982
Min. Negotiated Rate	$32,336.07
Max. Negotiated Rate	$46,430.08
Rate for Payer: AlohaCare Medicare	$32,336.07
Rate for Payer: Devoted Health Medicare	$35,569.68
Rate for Payer: Hawaii Medical Service Association Commercial	$46,430.08
Rate for Payer: Hawaii Medical Service Association Medicare	$32,336.07
Rate for Payer: Humana Medicare	$32,336.07
Rate for Payer: Kaiser Permanente Commercial	$42,409.12
Rate for Payer: Kaiser Permanente Medicare	$32,336.07
Rate for Payer: Ohana Health Plan Medicare	$32,336.07
Rate for Payer: UnitedHealthcare Medicare	$32,336.07

EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$80,933.55

Service Code	MSDRG 981
Min. Negotiated Rate	$61,710.14
Max. Negotiated Rate	$80,933.55
Rate for Payer: AlohaCare Medicare	$61,710.14
Rate for Payer: Devoted Health Medicare	$67,881.15
Rate for Payer: Hawaii Medical Service Association Commercial	$77,817.40
Rate for Payer: Hawaii Medical Service Association Medicare	$61,710.14
Rate for Payer: Humana Medicare	$61,710.14
Rate for Payer: Kaiser Permanente Commercial	$80,933.55
Rate for Payer: Kaiser Permanente Medicare	$61,710.14
Rate for Payer: Ohana Health Plan Medicare	$61,710.14
Rate for Payer: UnitedHealthcare Medicare	$61,710.14

EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$30,808.75

Service Code	MSDRG 983
Min. Negotiated Rate	$22,543.84
Max. Negotiated Rate	$30,808.75
Rate for Payer: AlohaCare Medicare	$22,543.84
Rate for Payer: Devoted Health Medicare	$24,798.22
Rate for Payer: Hawaii Medical Service Association Commercial	$30,808.75
Rate for Payer: Hawaii Medical Service Association Medicare	$22,543.84
Rate for Payer: Humana Medicare	$22,543.84
Rate for Payer: Kaiser Permanente Commercial	$29,566.50
Rate for Payer: Kaiser Permanente Medicare	$22,543.84
Rate for Payer: Ohana Health Plan Medicare	$22,543.84
Rate for Payer: UnitedHealthcare Medicare	$22,543.84

EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$9,440.60

Service Code	APR-DRG 9502
Min. Negotiated Rate	$9,440.60
Max. Negotiated Rate	$9,440.60
Rate for Payer: AlohaCare Medicaid	$9,440.60
Rate for Payer: Hawaii Medical Service Association ABD	$9,440.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,440.60
Rate for Payer: Kaiser Permanente Medicaid	$9,440.60
Rate for Payer: Ohana Health Plan Medicaid	$9,440.60
Rate for Payer: UnitedHealthcare Medicaid	$9,440.60

EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$12,038.12

Service Code	APR-DRG 9503
Min. Negotiated Rate	$12,038.12
Max. Negotiated Rate	$12,038.12
Rate for Payer: AlohaCare Medicaid	$12,038.12
Rate for Payer: Hawaii Medical Service Association ABD	$12,038.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,038.12
Rate for Payer: Kaiser Permanente Medicaid	$12,038.12
Rate for Payer: Ohana Health Plan Medicaid	$12,038.12
Rate for Payer: UnitedHealthcare Medicaid	$12,038.12

EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$24,681.85

Service Code	APR-DRG 9504
Min. Negotiated Rate	$24,681.85
Max. Negotiated Rate	$24,681.85
Rate for Payer: AlohaCare Medicaid	$24,681.85
Rate for Payer: Hawaii Medical Service Association ABD	$24,681.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24,681.85
Rate for Payer: Kaiser Permanente Medicaid	$24,681.85
Rate for Payer: Ohana Health Plan Medicaid	$24,681.85
Rate for Payer: UnitedHealthcare Medicaid	$24,681.85

EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$7,407.29

Service Code	APR-DRG 9501
Min. Negotiated Rate	$7,407.29
Max. Negotiated Rate	$7,407.29
Rate for Payer: AlohaCare Medicaid	$7,407.29
Rate for Payer: Hawaii Medical Service Association ABD	$7,407.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,407.29
Rate for Payer: Kaiser Permanente Medicaid	$7,407.29
Rate for Payer: Ohana Health Plan Medicaid	$7,407.29
Rate for Payer: UnitedHealthcare Medicaid	$7,407.29

External Fixator Clamp Lg Combo 390.005 [3601160]

Facility

$4,289.30

Hospital Charge Code	3601160
Hospital Revenue Code	272
Min. Negotiated Rate	$3,645.91
Max. Negotiated Rate	$4,160.62
Rate for Payer: Cash Price	$2,788.04
Rate for Payer: Health Management Network Commercial	$3,645.91
Rate for Payer: MDX Hawaii PPO	$4,160.62

External Fixator Clamp Lg Combo 390.005 [3601160]

Facility

$4,289.30

Hospital Charge Code	3601160
Hospital Revenue Code	272
Min. Negotiated Rate	$2,187.54
Max. Negotiated Rate	$4,160.62
Rate for Payer: Cash Price	$2,788.04
Rate for Payer: Hawaii Western Management Group Commercial	$4,074.84
Rate for Payer: Health Management Network Commercial	$3,645.91
Rate for Payer: Kaiser Permanente Commercial	$2,702.26
Rate for Payer: Kaiser Permanente Medicaid	$2,187.54
Rate for Payer: MDX Hawaii PPO	$4,160.62
Rate for Payer: University Health Alliance Commercial	$3,126.47

External Fixator Clamp Lg Pin 4 Pos 390.009 [3601195]

Facility

$3,123.80

Hospital Charge Code	3601195
Hospital Revenue Code	272
Min. Negotiated Rate	$1,593.14
Max. Negotiated Rate	$3,030.09
Rate for Payer: Cash Price	$2,030.47
Rate for Payer: Hawaii Western Management Group Commercial	$2,967.61
Rate for Payer: Health Management Network Commercial	$2,655.23
Rate for Payer: Kaiser Permanente Commercial	$1,967.99
Rate for Payer: Kaiser Permanente Medicaid	$1,593.14
Rate for Payer: MDX Hawaii PPO	$3,030.09
Rate for Payer: University Health Alliance Commercial	$2,276.94

External Fixator Clamp Lg Pin 4 Pos 390.009 [3601195]

Facility

$3,123.80

Hospital Charge Code	3601195
Hospital Revenue Code	272
Min. Negotiated Rate	$2,655.23
Max. Negotiated Rate	$3,030.09
Rate for Payer: Cash Price	$2,030.47
Rate for Payer: Health Management Network Commercial	$2,655.23
Rate for Payer: MDX Hawaii PPO	$3,030.09

External Fixator Clamp Lg Pin 6 Pos 390.010 [3640509]

Facility

$3,199.40

Hospital Charge Code	3640509
Hospital Revenue Code	272
Min. Negotiated Rate	$2,719.49
Max. Negotiated Rate	$3,103.42
Rate for Payer: Cash Price	$2,079.61
Rate for Payer: Health Management Network Commercial	$2,719.49
Rate for Payer: MDX Hawaii PPO	$3,103.42

External Fixator Clamp Lg Pin 6 Pos 390.010 [3640509]

Facility

$3,199.40

Hospital Charge Code	3640509
Hospital Revenue Code	272
Min. Negotiated Rate	$1,631.69
Max. Negotiated Rate	$3,103.42
Rate for Payer: Cash Price	$2,079.61
Rate for Payer: Hawaii Western Management Group Commercial	$3,039.43
Rate for Payer: Health Management Network Commercial	$2,719.49
Rate for Payer: Kaiser Permanente Commercial	$2,015.62
Rate for Payer: Kaiser Permanente Medicaid	$1,631.69
Rate for Payer: MDX Hawaii PPO	$3,103.42
Rate for Payer: University Health Alliance Commercial	$2,332.04

External Fixator Clamp Lg Tube To Tube 390.007 [3601156]

Facility

$4,412.15

Hospital Charge Code	3601156
Hospital Revenue Code	272
Min. Negotiated Rate	$2,250.20
Max. Negotiated Rate	$4,279.79
Rate for Payer: Cash Price	$2,867.90
Rate for Payer: Hawaii Western Management Group Commercial	$4,191.54
Rate for Payer: Health Management Network Commercial	$3,750.33
Rate for Payer: Kaiser Permanente Commercial	$2,779.65
Rate for Payer: Kaiser Permanente Medicaid	$2,250.20
Rate for Payer: MDX Hawaii PPO	$4,279.79
Rate for Payer: University Health Alliance Commercial	$3,216.02

External Fixator Clamp Lg Tube To Tube 390.007 [3601156]

Facility

$4,412.15

Hospital Charge Code	3601156
Hospital Revenue Code	272
Min. Negotiated Rate	$3,750.33
Max. Negotiated Rate	$4,279.79
Rate for Payer: Cash Price	$2,867.90
Rate for Payer: Health Management Network Commercial	$3,750.33
Rate for Payer: MDX Hawaii PPO	$4,279.79

External Fixator Fx Cap 5.0 394.993 [3601118]

Facility

$42.08

Hospital Charge Code	3601118
Hospital Revenue Code	272
Min. Negotiated Rate	$35.77
Max. Negotiated Rate	$40.82
Rate for Payer: Cash Price	$27.35
Rate for Payer: Health Management Network Commercial	$35.77
Rate for Payer: MDX Hawaii PPO	$40.82

External Fixator Fx Cap 5.0 394.993 [3601118]

Facility

$42.08

Hospital Charge Code	3601118
Hospital Revenue Code	272
Min. Negotiated Rate	$21.46
Max. Negotiated Rate	$40.82
Rate for Payer: Cash Price	$27.35
Rate for Payer: Hawaii Western Management Group Commercial	$39.98
Rate for Payer: Health Management Network Commercial	$35.77
Rate for Payer: Kaiser Permanente Commercial	$26.51
Rate for Payer: Kaiser Permanente Medicaid	$21.46
Rate for Payer: MDX Hawaii PPO	$40.82
Rate for Payer: University Health Alliance Commercial	$30.67

External Fixator Fx Rod 250 mm 394.84 [3601112]

Facility

$1,779.27

Hospital Charge Code	3601112
Hospital Revenue Code	272
Min. Negotiated Rate	$1,512.38
Max. Negotiated Rate	$1,725.89
Rate for Payer: Cash Price	$1,156.53
Rate for Payer: Health Management Network Commercial	$1,512.38
Rate for Payer: MDX Hawaii PPO	$1,725.89

Know your out-of-pocket cost for care.

All Charges