Kona Community Hospital

All Charges

Charge

Type

Setting

Price

NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$39,922.99

Service Code	APR-DRG 6082
Min. Negotiated Rate	$39,922.99
Max. Negotiated Rate	$39,922.99
Rate for Payer: AlohaCare Medicaid	$39,922.99
Rate for Payer: Hawaii Medical Service Association ABD	$39,922.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$39,922.99
Rate for Payer: Kaiser Permanente Medicaid	$39,922.99
Rate for Payer: Ohana Health Plan Medicaid	$39,922.99
Rate for Payer: UnitedHealthcare Medicaid	$39,922.99

NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$57,478.57

Service Code	APR-DRG 6083
Min. Negotiated Rate	$57,478.57
Max. Negotiated Rate	$57,478.57
Rate for Payer: AlohaCare Medicaid	$57,478.57
Rate for Payer: Hawaii Medical Service Association ABD	$57,478.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$57,478.57
Rate for Payer: Kaiser Permanente Medicaid	$57,478.57
Rate for Payer: Ohana Health Plan Medicaid	$57,478.57
Rate for Payer: UnitedHealthcare Medicaid	$57,478.57

NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$98,159.62

Service Code	APR-DRG 6084
Min. Negotiated Rate	$98,159.62
Max. Negotiated Rate	$98,159.62
Rate for Payer: AlohaCare Medicaid	$98,159.62
Rate for Payer: Hawaii Medical Service Association ABD	$98,159.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$98,159.62
Rate for Payer: Kaiser Permanente Medicaid	$98,159.62
Rate for Payer: Ohana Health Plan Medicaid	$98,159.62
Rate for Payer: UnitedHealthcare Medicaid	$98,159.62

NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$22,284.51

Service Code	APR-DRG 6081
Min. Negotiated Rate	$22,284.51
Max. Negotiated Rate	$22,284.51
Rate for Payer: AlohaCare Medicaid	$22,284.51
Rate for Payer: Hawaii Medical Service Association ABD	$22,284.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22,284.51
Rate for Payer: Kaiser Permanente Medicaid	$22,284.51
Rate for Payer: Ohana Health Plan Medicaid	$22,284.51
Rate for Payer: UnitedHealthcare Medicaid	$22,284.51

NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$54,377.28

Service Code	APR-DRG 6072
Min. Negotiated Rate	$54,377.28
Max. Negotiated Rate	$54,377.28
Rate for Payer: AlohaCare Medicaid	$54,377.28
Rate for Payer: Hawaii Medical Service Association ABD	$54,377.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$54,377.28
Rate for Payer: Kaiser Permanente Medicaid	$54,377.28
Rate for Payer: Ohana Health Plan Medicaid	$54,377.28
Rate for Payer: UnitedHealthcare Medicaid	$54,377.28

NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$70,707.93

Service Code	APR-DRG 6073
Min. Negotiated Rate	$70,707.93
Max. Negotiated Rate	$70,707.93
Rate for Payer: AlohaCare Medicaid	$70,707.93
Rate for Payer: Hawaii Medical Service Association ABD	$70,707.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$70,707.93
Rate for Payer: Kaiser Permanente Medicaid	$70,707.93
Rate for Payer: Ohana Health Plan Medicaid	$70,707.93
Rate for Payer: UnitedHealthcare Medicaid	$70,707.93

NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$105,138.02

Service Code	APR-DRG 6074
Min. Negotiated Rate	$105,138.02
Max. Negotiated Rate	$105,138.02
Rate for Payer: AlohaCare Medicaid	$105,138.02
Rate for Payer: Hawaii Medical Service Association ABD	$105,138.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$105,138.02
Rate for Payer: Kaiser Permanente Medicaid	$105,138.02
Rate for Payer: Ohana Health Plan Medicaid	$105,138.02
Rate for Payer: UnitedHealthcare Medicaid	$105,138.02

NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$39,963.46

Service Code	APR-DRG 6071
Min. Negotiated Rate	$39,963.46
Max. Negotiated Rate	$39,963.46
Rate for Payer: AlohaCare Medicaid	$39,963.46
Rate for Payer: Hawaii Medical Service Association ABD	$39,963.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$39,963.46
Rate for Payer: Kaiser Permanente Medicaid	$39,963.46
Rate for Payer: Ohana Health Plan Medicaid	$39,963.46
Rate for Payer: UnitedHealthcare Medicaid	$39,963.46

NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$66,462.65

Service Code	APR-DRG 6144
Min. Negotiated Rate	$66,462.65
Max. Negotiated Rate	$66,462.65
Rate for Payer: AlohaCare Medicaid	$66,462.65
Rate for Payer: Hawaii Medical Service Association ABD	$66,462.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$66,462.65
Rate for Payer: Kaiser Permanente Medicaid	$66,462.65
Rate for Payer: Ohana Health Plan Medicaid	$66,462.65
Rate for Payer: UnitedHealthcare Medicaid	$66,462.65

NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$12,275.87

Service Code	APR-DRG 6141
Min. Negotiated Rate	$12,275.87
Max. Negotiated Rate	$12,275.87
Rate for Payer: AlohaCare Medicaid	$12,275.87
Rate for Payer: Hawaii Medical Service Association ABD	$12,275.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,275.87
Rate for Payer: Kaiser Permanente Medicaid	$12,275.87
Rate for Payer: Ohana Health Plan Medicaid	$12,275.87
Rate for Payer: UnitedHealthcare Medicaid	$12,275.87

NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$23,847.99

Service Code	APR-DRG 6142
Min. Negotiated Rate	$23,847.99
Max. Negotiated Rate	$23,847.99
Rate for Payer: AlohaCare Medicaid	$23,847.99
Rate for Payer: Hawaii Medical Service Association ABD	$23,847.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23,847.99
Rate for Payer: Kaiser Permanente Medicaid	$23,847.99
Rate for Payer: Ohana Health Plan Medicaid	$23,847.99
Rate for Payer: UnitedHealthcare Medicaid	$23,847.99

NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$40,973.21

Service Code	APR-DRG 6143
Min. Negotiated Rate	$40,973.21
Max. Negotiated Rate	$40,973.21
Rate for Payer: AlohaCare Medicaid	$40,973.21
Rate for Payer: Hawaii Medical Service Association ABD	$40,973.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$40,973.21
Rate for Payer: Kaiser Permanente Medicaid	$40,973.21
Rate for Payer: Ohana Health Plan Medicaid	$40,973.21
Rate for Payer: UnitedHealthcare Medicaid	$40,973.21

NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$49,004.79

Service Code	APR-DRG 6123
Min. Negotiated Rate	$49,004.79
Max. Negotiated Rate	$49,004.79
Rate for Payer: AlohaCare Medicaid	$49,004.79
Rate for Payer: Hawaii Medical Service Association ABD	$49,004.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$49,004.79
Rate for Payer: Kaiser Permanente Medicaid	$49,004.79
Rate for Payer: Ohana Health Plan Medicaid	$49,004.79
Rate for Payer: UnitedHealthcare Medicaid	$49,004.79

NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$70,724.71

Service Code	APR-DRG 6124
Min. Negotiated Rate	$70,724.71
Max. Negotiated Rate	$70,724.71
Rate for Payer: AlohaCare Medicaid	$70,724.71
Rate for Payer: Hawaii Medical Service Association ABD	$70,724.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$70,724.71
Rate for Payer: Kaiser Permanente Medicaid	$70,724.71
Rate for Payer: Ohana Health Plan Medicaid	$70,724.71
Rate for Payer: UnitedHealthcare Medicaid	$70,724.71

NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$36,013.31

Service Code	APR-DRG 6122
Min. Negotiated Rate	$36,013.31
Max. Negotiated Rate	$36,013.31
Rate for Payer: AlohaCare Medicaid	$36,013.31
Rate for Payer: Hawaii Medical Service Association ABD	$36,013.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36,013.31
Rate for Payer: Kaiser Permanente Medicaid	$36,013.31
Rate for Payer: Ohana Health Plan Medicaid	$36,013.31
Rate for Payer: UnitedHealthcare Medicaid	$36,013.31

NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$25,553.60

Service Code	APR-DRG 6121
Min. Negotiated Rate	$25,553.60
Max. Negotiated Rate	$25,553.60
Rate for Payer: AlohaCare Medicaid	$25,553.60
Rate for Payer: Hawaii Medical Service Association ABD	$25,553.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$25,553.60
Rate for Payer: Kaiser Permanente Medicaid	$25,553.60
Rate for Payer: Ohana Health Plan Medicaid	$25,553.60
Rate for Payer: UnitedHealthcare Medicaid	$25,553.60

NEONATE BWT 1500-2499G W MAJOR PROCEDURE

Facility

$43,015.41

Service Code	APR-DRG 6092
Min. Negotiated Rate	$43,015.41
Max. Negotiated Rate	$43,015.41
Rate for Payer: AlohaCare Medicaid	$43,015.41
Rate for Payer: Hawaii Medical Service Association ABD	$43,015.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$43,015.41
Rate for Payer: Kaiser Permanente Medicaid	$43,015.41
Rate for Payer: Ohana Health Plan Medicaid	$43,015.41
Rate for Payer: UnitedHealthcare Medicaid	$43,015.41

NEONATE BWT 1500-2499G W MAJOR PROCEDURE

Facility

$70,835.26

Service Code	APR-DRG 6093
Min. Negotiated Rate	$70,835.26
Max. Negotiated Rate	$70,835.26
Rate for Payer: AlohaCare Medicaid	$70,835.26
Rate for Payer: Hawaii Medical Service Association ABD	$70,835.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$70,835.26
Rate for Payer: Kaiser Permanente Medicaid	$70,835.26
Rate for Payer: Ohana Health Plan Medicaid	$70,835.26
Rate for Payer: UnitedHealthcare Medicaid	$70,835.26

NEONATE BWT 1500-2499G W MAJOR PROCEDURE

Facility

$13,433.68

Service Code	APR-DRG 6091
Min. Negotiated Rate	$13,433.68
Max. Negotiated Rate	$13,433.68
Rate for Payer: AlohaCare Medicaid	$13,433.68
Rate for Payer: Hawaii Medical Service Association ABD	$13,433.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,433.68
Rate for Payer: Kaiser Permanente Medicaid	$13,433.68
Rate for Payer: Ohana Health Plan Medicaid	$13,433.68
Rate for Payer: UnitedHealthcare Medicaid	$13,433.68

NEONATE BWT 1500-2499G W MAJOR PROCEDURE

Facility

$152,679.03

Service Code	APR-DRG 6094
Min. Negotiated Rate	$152,679.03
Max. Negotiated Rate	$152,679.03
Rate for Payer: AlohaCare Medicaid	$152,679.03
Rate for Payer: Hawaii Medical Service Association ABD	$152,679.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$152,679.03
Rate for Payer: Kaiser Permanente Medicaid	$152,679.03
Rate for Payer: Ohana Health Plan Medicaid	$152,679.03
Rate for Payer: UnitedHealthcare Medicaid	$152,679.03

NEONATE BWT <1500G W MAJOR PROCEDURE

Facility

$192,781.66

Service Code	APR-DRG 5884
Min. Negotiated Rate	$192,781.66
Max. Negotiated Rate	$192,781.66
Rate for Payer: AlohaCare Medicaid	$192,781.66
Rate for Payer: Hawaii Medical Service Association ABD	$192,781.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$192,781.66
Rate for Payer: Kaiser Permanente Medicaid	$192,781.66
Rate for Payer: Ohana Health Plan Medicaid	$192,781.66
Rate for Payer: UnitedHealthcare Medicaid	$192,781.66

NEONATE BWT <1500G W MAJOR PROCEDURE

Facility

$123,658.93

Service Code	APR-DRG 5883
Min. Negotiated Rate	$123,658.93
Max. Negotiated Rate	$123,658.93
Rate for Payer: AlohaCare Medicaid	$123,658.93
Rate for Payer: Hawaii Medical Service Association ABD	$123,658.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$123,658.93
Rate for Payer: Kaiser Permanente Medicaid	$123,658.93
Rate for Payer: Ohana Health Plan Medicaid	$123,658.93
Rate for Payer: UnitedHealthcare Medicaid	$123,658.93

NEONATE BWT <1500G W MAJOR PROCEDURE

Facility

$56,103.62

Service Code	APR-DRG 5881
Min. Negotiated Rate	$56,103.62
Max. Negotiated Rate	$56,103.62
Rate for Payer: AlohaCare Medicaid	$56,103.62
Rate for Payer: Hawaii Medical Service Association ABD	$56,103.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$56,103.62
Rate for Payer: Kaiser Permanente Medicaid	$56,103.62
Rate for Payer: Ohana Health Plan Medicaid	$56,103.62
Rate for Payer: UnitedHealthcare Medicaid	$56,103.62

NEONATE BWT <1500G W MAJOR PROCEDURE

Facility

$81,165.67

Service Code	APR-DRG 5882
Min. Negotiated Rate	$81,165.67
Max. Negotiated Rate	$81,165.67
Rate for Payer: AlohaCare Medicaid	$81,165.67
Rate for Payer: Hawaii Medical Service Association ABD	$81,165.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$81,165.67
Rate for Payer: Kaiser Permanente Medicaid	$81,165.67
Rate for Payer: Ohana Health Plan Medicaid	$81,165.67
Rate for Payer: UnitedHealthcare Medicaid	$81,165.67

NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM

Facility

$1,613.31

Service Code	APR-DRG 6262
Min. Negotiated Rate	$1,613.31
Max. Negotiated Rate	$1,613.31
Rate for Payer: AlohaCare Medicaid	$1,613.31
Rate for Payer: Hawaii Medical Service Association ABD	$1,613.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,613.31
Rate for Payer: Kaiser Permanente Medicaid	$1,613.31
Rate for Payer: Ohana Health Plan Medicaid	$1,613.31
Rate for Payer: UnitedHealthcare Medicaid	$1,613.31

Know your out-of-pocket cost for care.

All Charges