Kona Community Hospital

All Charges

Charge

Type

Setting

Price

NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE

Facility

$125,080.27

Service Code	APR-DRG 6304
Min. Negotiated Rate	$125,080.27
Max. Negotiated Rate	$125,080.27
Rate for Payer: AlohaCare Medicaid	$125,080.27
Rate for Payer: Hawaii Medical Service Association ABD	$125,080.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$125,080.27
Rate for Payer: Kaiser Permanente Medicaid	$125,080.27
Rate for Payer: Ohana Health Plan Medicaid	$125,080.27
Rate for Payer: UnitedHealthcare Medicaid	$125,080.27

NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE

Facility

$13,728.80

Service Code	APR-DRG 6311
Min. Negotiated Rate	$13,728.80
Max. Negotiated Rate	$13,728.80
Rate for Payer: AlohaCare Medicaid	$13,728.80
Rate for Payer: Hawaii Medical Service Association ABD	$13,728.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,728.80
Rate for Payer: Kaiser Permanente Medicaid	$13,728.80
Rate for Payer: Ohana Health Plan Medicaid	$13,728.80
Rate for Payer: UnitedHealthcare Medicaid	$13,728.80

NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE

Facility

$30,092.03

Service Code	APR-DRG 6312
Min. Negotiated Rate	$30,092.03
Max. Negotiated Rate	$30,092.03
Rate for Payer: AlohaCare Medicaid	$30,092.03
Rate for Payer: Hawaii Medical Service Association ABD	$30,092.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30,092.03
Rate for Payer: Kaiser Permanente Medicaid	$30,092.03
Rate for Payer: Ohana Health Plan Medicaid	$30,092.03
Rate for Payer: UnitedHealthcare Medicaid	$30,092.03

NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE

Facility

$50,785.42

Service Code	APR-DRG 6313
Min. Negotiated Rate	$50,785.42
Max. Negotiated Rate	$50,785.42
Rate for Payer: AlohaCare Medicaid	$50,785.42
Rate for Payer: Hawaii Medical Service Association ABD	$50,785.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50,785.42
Rate for Payer: Kaiser Permanente Medicaid	$50,785.42
Rate for Payer: Ohana Health Plan Medicaid	$50,785.42
Rate for Payer: UnitedHealthcare Medicaid	$50,785.42

NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE

Facility

$108,675.59

Service Code	APR-DRG 6314
Min. Negotiated Rate	$108,675.59
Max. Negotiated Rate	$108,675.59
Rate for Payer: AlohaCare Medicaid	$108,675.59
Rate for Payer: Hawaii Medical Service Association ABD	$108,675.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$108,675.59
Rate for Payer: Kaiser Permanente Medicaid	$108,675.59
Rate for Payer: Ohana Health Plan Medicaid	$108,675.59
Rate for Payer: UnitedHealthcare Medicaid	$108,675.59

NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION

Facility

$26,104.37

Service Code	APR-DRG 6394
Min. Negotiated Rate	$26,104.37
Max. Negotiated Rate	$26,104.37
Rate for Payer: AlohaCare Medicaid	$26,104.37
Rate for Payer: Hawaii Medical Service Association ABD	$26,104.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26,104.37
Rate for Payer: Kaiser Permanente Medicaid	$26,104.37
Rate for Payer: Ohana Health Plan Medicaid	$26,104.37
Rate for Payer: UnitedHealthcare Medicaid	$26,104.37

NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION

Facility

$15,736.45

Service Code	APR-DRG 6393
Min. Negotiated Rate	$15,736.45
Max. Negotiated Rate	$15,736.45
Rate for Payer: AlohaCare Medicaid	$15,736.45
Rate for Payer: Hawaii Medical Service Association ABD	$15,736.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15,736.45
Rate for Payer: Kaiser Permanente Medicaid	$15,736.45
Rate for Payer: Ohana Health Plan Medicaid	$15,736.45
Rate for Payer: UnitedHealthcare Medicaid	$15,736.45

NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION

Facility

$9,905.98

Service Code	APR-DRG 6392
Min. Negotiated Rate	$9,905.98
Max. Negotiated Rate	$9,905.98
Rate for Payer: AlohaCare Medicaid	$9,905.98
Rate for Payer: Hawaii Medical Service Association ABD	$9,905.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,905.98
Rate for Payer: Kaiser Permanente Medicaid	$9,905.98
Rate for Payer: Ohana Health Plan Medicaid	$9,905.98
Rate for Payer: UnitedHealthcare Medicaid	$9,905.98

NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION

Facility

$5,006.29

Service Code	APR-DRG 6391
Min. Negotiated Rate	$5,006.29
Max. Negotiated Rate	$5,006.29
Rate for Payer: AlohaCare Medicaid	$5,006.29
Rate for Payer: Hawaii Medical Service Association ABD	$5,006.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,006.29
Rate for Payer: Kaiser Permanente Medicaid	$5,006.29
Rate for Payer: Ohana Health Plan Medicaid	$5,006.29
Rate for Payer: UnitedHealthcare Medicaid	$5,006.29

NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$42,038.23

Service Code	APR-DRG 6344
Min. Negotiated Rate	$42,038.23
Max. Negotiated Rate	$42,038.23
Rate for Payer: AlohaCare Medicaid	$42,038.23
Rate for Payer: Hawaii Medical Service Association ABD	$42,038.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$42,038.23
Rate for Payer: Kaiser Permanente Medicaid	$42,038.23
Rate for Payer: Ohana Health Plan Medicaid	$42,038.23
Rate for Payer: UnitedHealthcare Medicaid	$42,038.23

NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$6,551.02

Service Code	APR-DRG 6341
Min. Negotiated Rate	$6,551.02
Max. Negotiated Rate	$6,551.02
Rate for Payer: AlohaCare Medicaid	$6,551.02
Rate for Payer: Hawaii Medical Service Association ABD	$6,551.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,551.02
Rate for Payer: Kaiser Permanente Medicaid	$6,551.02
Rate for Payer: Ohana Health Plan Medicaid	$6,551.02
Rate for Payer: UnitedHealthcare Medicaid	$6,551.02

NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$12,322.27

Service Code	APR-DRG 6342
Min. Negotiated Rate	$12,322.27
Max. Negotiated Rate	$12,322.27
Rate for Payer: AlohaCare Medicaid	$12,322.27
Rate for Payer: Hawaii Medical Service Association ABD	$12,322.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,322.27
Rate for Payer: Kaiser Permanente Medicaid	$12,322.27
Rate for Payer: Ohana Health Plan Medicaid	$12,322.27
Rate for Payer: UnitedHealthcare Medicaid	$12,322.27

NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$16,626.77

Service Code	APR-DRG 6343
Min. Negotiated Rate	$16,626.77
Max. Negotiated Rate	$16,626.77
Rate for Payer: AlohaCare Medicaid	$16,626.77
Rate for Payer: Hawaii Medical Service Association ABD	$16,626.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16,626.77
Rate for Payer: Kaiser Permanente Medicaid	$16,626.77
Rate for Payer: Ohana Health Plan Medicaid	$16,626.77
Rate for Payer: UnitedHealthcare Medicaid	$16,626.77

NEONATE BIRTHWT 500-749G W/O MAJOR PROCEDURE

Facility

$193,566.37

Service Code	APR-DRG 5914
Min. Negotiated Rate	$193,566.37
Max. Negotiated Rate	$193,566.37
Rate for Payer: AlohaCare Medicaid	$193,566.37
Rate for Payer: Hawaii Medical Service Association ABD	$193,566.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$193,566.37
Rate for Payer: Kaiser Permanente Medicaid	$193,566.37
Rate for Payer: Ohana Health Plan Medicaid	$193,566.37
Rate for Payer: UnitedHealthcare Medicaid	$193,566.37

NEONATE BIRTHWT 500-749G W/O MAJOR PROCEDURE

Facility

$1,872.42

Service Code	APR-DRG 5911
Min. Negotiated Rate	$1,872.42
Max. Negotiated Rate	$1,872.42
Rate for Payer: AlohaCare Medicaid	$1,872.42
Rate for Payer: Hawaii Medical Service Association ABD	$1,872.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,872.42
Rate for Payer: Kaiser Permanente Medicaid	$1,872.42
Rate for Payer: Ohana Health Plan Medicaid	$1,872.42
Rate for Payer: UnitedHealthcare Medicaid	$1,872.42

NEONATE BIRTHWT 500-749G W/O MAJOR PROCEDURE

Facility

$133,981.44

Service Code	APR-DRG 5912
Min. Negotiated Rate	$133,981.44
Max. Negotiated Rate	$133,981.44
Rate for Payer: AlohaCare Medicaid	$133,981.44
Rate for Payer: Hawaii Medical Service Association ABD	$133,981.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$133,981.44
Rate for Payer: Kaiser Permanente Medicaid	$133,981.44
Rate for Payer: Ohana Health Plan Medicaid	$133,981.44
Rate for Payer: UnitedHealthcare Medicaid	$133,981.44

NEONATE BIRTHWT 500-749G W/O MAJOR PROCEDURE

Facility

$152,584.27

Service Code	APR-DRG 5913
Min. Negotiated Rate	$152,584.27
Max. Negotiated Rate	$152,584.27
Rate for Payer: AlohaCare Medicaid	$152,584.27
Rate for Payer: Hawaii Medical Service Association ABD	$152,584.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$152,584.27
Rate for Payer: Kaiser Permanente Medicaid	$152,584.27
Rate for Payer: Ohana Health Plan Medicaid	$152,584.27
Rate for Payer: UnitedHealthcare Medicaid	$152,584.27

NEONATE BIRTHWT 750-999G W/O MAJOR PROCEDURE

Facility

$105,486.45

Service Code	APR-DRG 5932
Min. Negotiated Rate	$105,486.45
Max. Negotiated Rate	$105,486.45
Rate for Payer: AlohaCare Medicaid	$105,486.45
Rate for Payer: Hawaii Medical Service Association ABD	$105,486.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$105,486.45
Rate for Payer: Kaiser Permanente Medicaid	$105,486.45
Rate for Payer: Ohana Health Plan Medicaid	$105,486.45
Rate for Payer: UnitedHealthcare Medicaid	$105,486.45

NEONATE BIRTHWT 750-999G W/O MAJOR PROCEDURE

Facility

$122,338.26

Service Code	APR-DRG 5933
Min. Negotiated Rate	$122,338.26
Max. Negotiated Rate	$122,338.26
Rate for Payer: AlohaCare Medicaid	$122,338.26
Rate for Payer: Hawaii Medical Service Association ABD	$122,338.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$122,338.26
Rate for Payer: Kaiser Permanente Medicaid	$122,338.26
Rate for Payer: Ohana Health Plan Medicaid	$122,338.26
Rate for Payer: UnitedHealthcare Medicaid	$122,338.26

NEONATE BIRTHWT 750-999G W/O MAJOR PROCEDURE

Facility

$166,852.00

Service Code	APR-DRG 5934
Min. Negotiated Rate	$166,852.00
Max. Negotiated Rate	$166,852.00
Rate for Payer: AlohaCare Medicaid	$166,852.00
Rate for Payer: Hawaii Medical Service Association ABD	$166,852.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$166,852.00
Rate for Payer: Kaiser Permanente Medicaid	$166,852.00
Rate for Payer: Ohana Health Plan Medicaid	$166,852.00
Rate for Payer: UnitedHealthcare Medicaid	$166,852.00

NEONATE BIRTHWT 750-999G W/O MAJOR PROCEDURE

Facility

$5,396.17

Service Code	APR-DRG 5931
Min. Negotiated Rate	$5,396.17
Max. Negotiated Rate	$5,396.17
Rate for Payer: AlohaCare Medicaid	$5,396.17
Rate for Payer: Hawaii Medical Service Association ABD	$5,396.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,396.17
Rate for Payer: Kaiser Permanente Medicaid	$5,396.17
Rate for Payer: Ohana Health Plan Medicaid	$5,396.17
Rate for Payer: UnitedHealthcare Medicaid	$5,396.17

NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$75,728.04

Service Code	APR-DRG 6022
Min. Negotiated Rate	$75,728.04
Max. Negotiated Rate	$75,728.04
Rate for Payer: AlohaCare Medicaid	$75,728.04
Rate for Payer: Hawaii Medical Service Association ABD	$75,728.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$75,728.04
Rate for Payer: Kaiser Permanente Medicaid	$75,728.04
Rate for Payer: Ohana Health Plan Medicaid	$75,728.04
Rate for Payer: UnitedHealthcare Medicaid	$75,728.04

NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$34,119.17

Service Code	APR-DRG 6021
Min. Negotiated Rate	$34,119.17
Max. Negotiated Rate	$34,119.17
Rate for Payer: AlohaCare Medicaid	$34,119.17
Rate for Payer: Hawaii Medical Service Association ABD	$34,119.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$34,119.17
Rate for Payer: Kaiser Permanente Medicaid	$34,119.17
Rate for Payer: Ohana Health Plan Medicaid	$34,119.17
Rate for Payer: UnitedHealthcare Medicaid	$34,119.17

NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$96,941.60

Service Code	APR-DRG 6023
Min. Negotiated Rate	$96,941.60
Max. Negotiated Rate	$96,941.60
Rate for Payer: AlohaCare Medicaid	$96,941.60
Rate for Payer: Hawaii Medical Service Association ABD	$96,941.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$96,941.60
Rate for Payer: Kaiser Permanente Medicaid	$96,941.60
Rate for Payer: Ohana Health Plan Medicaid	$96,941.60
Rate for Payer: UnitedHealthcare Medicaid	$96,941.60

NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$135,053.37

Service Code	APR-DRG 6024
Min. Negotiated Rate	$135,053.37
Max. Negotiated Rate	$135,053.37
Rate for Payer: AlohaCare Medicaid	$135,053.37
Rate for Payer: Hawaii Medical Service Association ABD	$135,053.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$135,053.37
Rate for Payer: Kaiser Permanente Medicaid	$135,053.37
Rate for Payer: Ohana Health Plan Medicaid	$135,053.37
Rate for Payer: UnitedHealthcare Medicaid	$135,053.37

Know your out-of-pocket cost for care.

All Charges