Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE

Facility

$13,361.24

Service Code	APR-DRG 0554
Min. Negotiated Rate	$13,361.24
Max. Negotiated Rate	$13,361.24
Rate for Payer: AlohaCare Medicaid	$13,361.24
Rate for Payer: Hawaii Medical Service Association ABD	$13,361.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,361.24
Rate for Payer: Kaiser Permanente Medicaid	$13,361.24
Rate for Payer: Ohana Health Plan Medicaid	$13,361.24
Rate for Payer: UnitedHealthcare Medicaid	$13,361.24

HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE

Facility

$7,088.89

Service Code	APR-DRG 0553
Min. Negotiated Rate	$7,088.89
Max. Negotiated Rate	$7,088.89
Rate for Payer: AlohaCare Medicaid	$7,088.89
Rate for Payer: Hawaii Medical Service Association ABD	$7,088.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,088.89
Rate for Payer: Kaiser Permanente Medicaid	$7,088.89
Rate for Payer: Ohana Health Plan Medicaid	$7,088.89
Rate for Payer: UnitedHealthcare Medicaid	$7,088.89

HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE

Facility

$4,869.95

Service Code	APR-DRG 0552
Min. Negotiated Rate	$4,869.95
Max. Negotiated Rate	$4,869.95
Rate for Payer: AlohaCare Medicaid	$4,869.95
Rate for Payer: Hawaii Medical Service Association ABD	$4,869.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,869.95
Rate for Payer: Kaiser Permanente Medicaid	$4,869.95
Rate for Payer: Ohana Health Plan Medicaid	$4,869.95
Rate for Payer: UnitedHealthcare Medicaid	$4,869.95

HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE

Facility

$3,577.40

Service Code	APR-DRG 0551
Min. Negotiated Rate	$3,577.40
Max. Negotiated Rate	$3,577.40
Rate for Payer: AlohaCare Medicaid	$3,577.40
Rate for Payer: Hawaii Medical Service Association ABD	$3,577.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,577.40
Rate for Payer: Kaiser Permanente Medicaid	$3,577.40
Rate for Payer: Ohana Health Plan Medicaid	$3,577.40
Rate for Payer: UnitedHealthcare Medicaid	$3,577.40

HEART FAILURE

Facility

$4,824.42

Service Code	APR-DRG 1943
Min. Negotiated Rate	$4,824.42
Max. Negotiated Rate	$4,824.42
Rate for Payer: AlohaCare Medicaid	$4,824.42
Rate for Payer: Hawaii Medical Service Association ABD	$4,824.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,824.42
Rate for Payer: Kaiser Permanente Medicaid	$4,824.42
Rate for Payer: Ohana Health Plan Medicaid	$4,824.42
Rate for Payer: UnitedHealthcare Medicaid	$4,824.42

HEART FAILURE

Facility

$7,219.44

Service Code	APR-DRG 1944
Min. Negotiated Rate	$7,219.44
Max. Negotiated Rate	$7,219.44
Rate for Payer: AlohaCare Medicaid	$7,219.44
Rate for Payer: Hawaii Medical Service Association ABD	$7,219.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,219.44
Rate for Payer: Kaiser Permanente Medicaid	$7,219.44
Rate for Payer: Ohana Health Plan Medicaid	$7,219.44
Rate for Payer: UnitedHealthcare Medicaid	$7,219.44

HEART FAILURE

Facility

$2,665.66

Service Code	APR-DRG 1941
Min. Negotiated Rate	$2,665.66
Max. Negotiated Rate	$2,665.66
Rate for Payer: AlohaCare Medicaid	$2,665.66
Rate for Payer: Hawaii Medical Service Association ABD	$2,665.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,665.66
Rate for Payer: Kaiser Permanente Medicaid	$2,665.66
Rate for Payer: Ohana Health Plan Medicaid	$2,665.66
Rate for Payer: UnitedHealthcare Medicaid	$2,665.66

HEART FAILURE

Facility

$3,448.93

Service Code	APR-DRG 1942
Min. Negotiated Rate	$3,448.93
Max. Negotiated Rate	$3,448.93
Rate for Payer: AlohaCare Medicaid	$3,448.93
Rate for Payer: Hawaii Medical Service Association ABD	$3,448.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,448.93
Rate for Payer: Kaiser Permanente Medicaid	$3,448.93
Rate for Payer: Ohana Health Plan Medicaid	$3,448.93
Rate for Payer: UnitedHealthcare Medicaid	$3,448.93

HEART FAILURE AND SHOCK WITH CC

Facility

$29,000.72

Service Code	MSDRG 292
Min. Negotiated Rate	$11,166.70
Max. Negotiated Rate	$29,000.72
Rate for Payer: AlohaCare Medicare	$11,166.70
Rate for Payer: Devoted Health Medicare	$12,283.37
Rate for Payer: Hawaii Medical Service Association Commercial	$29,000.72
Rate for Payer: Hawaii Medical Service Association Medicare	$11,166.70
Rate for Payer: Humana Medicare	$11,166.70
Rate for Payer: Kaiser Permanente Commercial	$14,645.25
Rate for Payer: Kaiser Permanente Medicare	$11,166.70
Rate for Payer: Ohana Health Plan Medicare	$11,166.70
Rate for Payer: UnitedHealthcare Medicare	$11,166.70

HEART FAILURE AND SHOCK WITH MCC

Facility

$29,000.72

Service Code	MSDRG 291
Min. Negotiated Rate	$16,885.52
Max. Negotiated Rate	$29,000.72
Rate for Payer: AlohaCare Medicare	$16,885.52
Rate for Payer: Devoted Health Medicare	$18,574.07
Rate for Payer: Hawaii Medical Service Association Commercial	$29,000.72
Rate for Payer: Hawaii Medical Service Association Medicare	$16,885.52
Rate for Payer: Humana Medicare	$16,885.52
Rate for Payer: Kaiser Permanente Commercial	$22,145.55
Rate for Payer: Kaiser Permanente Medicare	$16,885.52
Rate for Payer: Ohana Health Plan Medicare	$16,885.52
Rate for Payer: UnitedHealthcare Medicare	$16,885.52

HEART FAILURE AND SHOCK WITHOUT CC/MCC

Facility

$29,000.72

Service Code	MSDRG 293
Min. Negotiated Rate	$7,444.46
Max. Negotiated Rate	$29,000.72
Rate for Payer: AlohaCare Medicare	$7,444.46
Rate for Payer: Devoted Health Medicare	$8,188.91
Rate for Payer: Hawaii Medical Service Association Commercial	$29,000.72
Rate for Payer: Hawaii Medical Service Association Medicare	$7,444.46
Rate for Payer: Humana Medicare	$7,444.46
Rate for Payer: Kaiser Permanente Commercial	$9,763.50
Rate for Payer: Kaiser Permanente Medicare	$7,444.46
Rate for Payer: Ohana Health Plan Medicare	$7,444.46
Rate for Payer: UnitedHealthcare Medicare	$7,444.46

HEART &/OR LUNG TRANSPLANT

Facility

$73,104.98

Service Code	APR-DRG 0023
Min. Negotiated Rate	$73,104.98
Max. Negotiated Rate	$73,104.98
Rate for Payer: AlohaCare Medicaid	$73,104.98
Rate for Payer: Hawaii Medical Service Association ABD	$73,104.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$73,104.98
Rate for Payer: Kaiser Permanente Medicaid	$73,104.98
Rate for Payer: Ohana Health Plan Medicaid	$73,104.98
Rate for Payer: UnitedHealthcare Medicaid	$73,104.98

HEART &/OR LUNG TRANSPLANT

Facility

$42,820.54

Service Code	APR-DRG 0021
Min. Negotiated Rate	$42,820.54
Max. Negotiated Rate	$42,820.54
Rate for Payer: AlohaCare Medicaid	$42,820.54
Rate for Payer: Hawaii Medical Service Association ABD	$42,820.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$42,820.54
Rate for Payer: Kaiser Permanente Medicaid	$42,820.54
Rate for Payer: Ohana Health Plan Medicaid	$42,820.54
Rate for Payer: UnitedHealthcare Medicaid	$42,820.54

HEART &/OR LUNG TRANSPLANT

Facility

$104,059.34

Service Code	APR-DRG 0024
Min. Negotiated Rate	$104,059.34
Max. Negotiated Rate	$104,059.34
Rate for Payer: AlohaCare Medicaid	$104,059.34
Rate for Payer: Hawaii Medical Service Association ABD	$104,059.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$104,059.34
Rate for Payer: Kaiser Permanente Medicaid	$104,059.34
Rate for Payer: Ohana Health Plan Medicaid	$104,059.34
Rate for Payer: UnitedHealthcare Medicaid	$104,059.34

HEART &/OR LUNG TRANSPLANT

Facility

$52,289.80

Service Code	APR-DRG 0022
Min. Negotiated Rate	$52,289.80
Max. Negotiated Rate	$52,289.80
Rate for Payer: AlohaCare Medicaid	$52,289.80
Rate for Payer: Hawaii Medical Service Association ABD	$52,289.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$52,289.80
Rate for Payer: Kaiser Permanente Medicaid	$52,289.80
Rate for Payer: Ohana Health Plan Medicaid	$52,289.80
Rate for Payer: UnitedHealthcare Medicaid	$52,289.80

HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC

Facility

$483,412.28

Service Code	MSDRG 001
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$483,412.28
Rate for Payer: AlohaCare Medicare	$368,591.80
Rate for Payer: Devoted Health Medicare	$405,450.98
Rate for Payer: Hawaii Medical Service Association Commercial	$274,651.05
Rate for Payer: Hawaii Medical Service Association Medicare	$368,591.80
Rate for Payer: Kaiser Permanente Commercial	$483,412.28
Rate for Payer: Kaiser Permanente Medicare	$368,591.80
Rate for Payer: Ohana Health Plan Medicare	$368,591.80
Rate for Payer: UnitedHealthcare Medicare	$368,591.80
Rate for Payer: University Health Alliance Commercial	$10,400.00

HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC

Facility

$274,651.05

Service Code	MSDRG 002
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$274,651.05
Rate for Payer: AlohaCare Medicare	$149,044.50
Rate for Payer: Devoted Health Medicare	$163,948.95
Rate for Payer: Hawaii Medical Service Association Commercial	$274,651.05
Rate for Payer: Hawaii Medical Service Association Medicare	$149,044.50
Rate for Payer: Kaiser Permanente Commercial	$195,473.55
Rate for Payer: Kaiser Permanente Medicare	$149,044.50
Rate for Payer: Ohana Health Plan Medicare	$149,044.50
Rate for Payer: UnitedHealthcare Medicare	$149,044.50
Rate for Payer: University Health Alliance Commercial	$10,400.00

Helical Blade TFNA Fen 100mm 04.038.400S [3640789A]

Facility

$4,793.62

Service Code	HCPCS C1713
Hospital Charge Code	3640789A
Hospital Revenue Code	278
Min. Negotiated Rate	$2,444.75
Max. Negotiated Rate	$4,649.81
Rate for Payer: Cash Price	$3,115.85
Rate for Payer: Hawaii Western Management Group Commercial	$3,355.53
Rate for Payer: Health Management Network Commercial	$4,074.58
Rate for Payer: Kaiser Permanente Commercial	$3,019.98
Rate for Payer: Kaiser Permanente Medicaid	$2,444.75
Rate for Payer: MDX Hawaii PPO	$4,649.81
Rate for Payer: University Health Alliance Commercial	$2,684.43

Helical Blade TFNA Fen 100mm 04.038.400S [3640789A]

Facility

$4,793.62

Service Code	HCPCS C1713
Hospital Charge Code	3640789A
Hospital Revenue Code	278
Min. Negotiated Rate	$2,684.43
Max. Negotiated Rate	$4,649.81
Rate for Payer: Cash Price	$3,115.85
Rate for Payer: Hawaii Western Management Group Commercial	$3,355.53
Rate for Payer: Health Management Network Commercial	$4,074.58
Rate for Payer: MDX Hawaii PPO	$4,649.81
Rate for Payer: University Health Alliance Commercial	$2,684.43

Helical Blade TFNA Fen 110mm 04.038.410S [3640789C]

Facility

$4,793.62

Service Code	HCPCS C1713
Hospital Charge Code	3640789C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,444.75
Max. Negotiated Rate	$4,649.81
Rate for Payer: Cash Price	$3,115.85
Rate for Payer: Hawaii Western Management Group Commercial	$3,355.53
Rate for Payer: Health Management Network Commercial	$4,074.58
Rate for Payer: Kaiser Permanente Commercial	$3,019.98
Rate for Payer: Kaiser Permanente Medicaid	$2,444.75
Rate for Payer: MDX Hawaii PPO	$4,649.81
Rate for Payer: University Health Alliance Commercial	$2,684.43

Helical Blade TFNA Fen 110mm 04.038.410S [3640789C]

Facility

$4,793.62

Service Code	HCPCS C1713
Hospital Charge Code	3640789C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,684.43
Max. Negotiated Rate	$4,649.81
Rate for Payer: Cash Price	$3,115.85
Rate for Payer: Hawaii Western Management Group Commercial	$3,355.53
Rate for Payer: Health Management Network Commercial	$4,074.58
Rate for Payer: MDX Hawaii PPO	$4,649.81
Rate for Payer: University Health Alliance Commercial	$2,684.43

Helical Blade TFNA Fen 115mm 04.038.415S [3640789E]

Facility

$4,499.00

Service Code	HCPCS C1713
Hospital Charge Code	3640789E
Hospital Revenue Code	272
Min. Negotiated Rate	$3,824.15
Max. Negotiated Rate	$4,364.03
Rate for Payer: Cash Price	$2,924.35
Rate for Payer: Health Management Network Commercial	$3,824.15
Rate for Payer: MDX Hawaii PPO	$4,364.03

Helical Blade TFNA Fen 115mm 04.038.415S [3640789E]

Facility

$4,499.00

Service Code	HCPCS C1713
Hospital Charge Code	3640789E
Hospital Revenue Code	272
Min. Negotiated Rate	$2,294.49
Max. Negotiated Rate	$4,364.03
Rate for Payer: Cash Price	$2,924.35
Rate for Payer: Hawaii Western Management Group Commercial	$4,274.05
Rate for Payer: Health Management Network Commercial	$3,824.15
Rate for Payer: Kaiser Permanente Commercial	$2,834.37
Rate for Payer: Kaiser Permanente Medicaid	$2,294.49
Rate for Payer: MDX Hawaii PPO	$4,364.03
Rate for Payer: University Health Alliance Commercial	$3,279.32

Helical Blade TFNA Fen 120mm 04.038.420S [3641520]

Facility

$4,499.00

Service Code	HCPCS C1776
Hospital Charge Code	3641520
Hospital Revenue Code	278
Min. Negotiated Rate	$2,519.44
Max. Negotiated Rate	$4,364.03
Rate for Payer: Cash Price	$2,924.35
Rate for Payer: Hawaii Western Management Group Commercial	$3,149.30
Rate for Payer: Health Management Network Commercial	$3,824.15
Rate for Payer: MDX Hawaii PPO	$4,364.03
Rate for Payer: University Health Alliance Commercial	$2,519.44

Helical Blade TFNA Fen 120mm 04.038.420S [3641520]

Facility

$4,499.00

Service Code	HCPCS C1776
Hospital Charge Code	3641520
Hospital Revenue Code	278
Min. Negotiated Rate	$2,294.49
Max. Negotiated Rate	$4,364.03
Rate for Payer: Cash Price	$2,924.35
Rate for Payer: Hawaii Western Management Group Commercial	$3,149.30
Rate for Payer: Health Management Network Commercial	$3,824.15
Rate for Payer: Kaiser Permanente Commercial	$2,834.37
Rate for Payer: Kaiser Permanente Medicaid	$2,294.49
Rate for Payer: MDX Hawaii PPO	$4,364.03
Rate for Payer: University Health Alliance Commercial	$2,519.44

Know your out-of-pocket cost for care.

All Charges