Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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

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

Facility

$4,333.16

Service Code	APR-DRG 6263
Min. Negotiated Rate	$4,333.16
Max. Negotiated Rate	$4,333.16
Rate for Payer: AlohaCare Medicaid	$4,333.16
Rate for Payer: Hawaii Medical Service Association ABD	$4,333.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,333.16
Rate for Payer: Kaiser Permanente Medicaid	$4,333.16
Rate for Payer: Ohana Health Plan Medicaid	$4,333.16
Rate for Payer: UnitedHealthcare Medicaid	$4,333.16

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

Facility

$20,970.81

Service Code	APR-DRG 6264
Min. Negotiated Rate	$20,970.81
Max. Negotiated Rate	$20,970.81
Rate for Payer: AlohaCare Medicaid	$20,970.81
Rate for Payer: Hawaii Medical Service Association ABD	$20,970.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20,970.81
Rate for Payer: Kaiser Permanente Medicaid	$20,970.81
Rate for Payer: Ohana Health Plan Medicaid	$20,970.81
Rate for Payer: UnitedHealthcare Medicaid	$20,970.81

NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION

Facility

$33,578.27

Service Code	APR-DRG 6234
Min. Negotiated Rate	$33,578.27
Max. Negotiated Rate	$33,578.27
Rate for Payer: AlohaCare Medicaid	$33,578.27
Rate for Payer: Hawaii Medical Service Association ABD	$33,578.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$33,578.27
Rate for Payer: Kaiser Permanente Medicaid	$33,578.27
Rate for Payer: Ohana Health Plan Medicaid	$33,578.27
Rate for Payer: UnitedHealthcare Medicaid	$33,578.27

NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION

Facility

$16,139.17

Service Code	APR-DRG 6232
Min. Negotiated Rate	$16,139.17
Max. Negotiated Rate	$16,139.17
Rate for Payer: AlohaCare Medicaid	$16,139.17
Rate for Payer: Hawaii Medical Service Association ABD	$16,139.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16,139.17
Rate for Payer: Kaiser Permanente Medicaid	$16,139.17
Rate for Payer: Ohana Health Plan Medicaid	$16,139.17
Rate for Payer: UnitedHealthcare Medicaid	$16,139.17

NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION

Facility

$11,232.57

Service Code	APR-DRG 6231
Min. Negotiated Rate	$11,232.57
Max. Negotiated Rate	$11,232.57
Rate for Payer: AlohaCare Medicaid	$11,232.57
Rate for Payer: Hawaii Medical Service Association ABD	$11,232.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,232.57
Rate for Payer: Kaiser Permanente Medicaid	$11,232.57
Rate for Payer: Ohana Health Plan Medicaid	$11,232.57
Rate for Payer: UnitedHealthcare Medicaid	$11,232.57

NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION

Facility

$27,949.16

Service Code	APR-DRG 6233
Min. Negotiated Rate	$27,949.16
Max. Negotiated Rate	$27,949.16
Rate for Payer: AlohaCare Medicaid	$27,949.16
Rate for Payer: Hawaii Medical Service Association ABD	$27,949.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27,949.16
Rate for Payer: Kaiser Permanente Medicaid	$27,949.16
Rate for Payer: Ohana Health Plan Medicaid	$27,949.16
Rate for Payer: UnitedHealthcare Medicaid	$27,949.16

NEONATE BWT 2000-2499G W MAJOR ANOMALY

Facility

$18,474.51

Service Code	APR-DRG 6212
Min. Negotiated Rate	$18,474.51
Max. Negotiated Rate	$18,474.51
Rate for Payer: AlohaCare Medicaid	$18,474.51
Rate for Payer: Hawaii Medical Service Association ABD	$18,474.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18,474.51
Rate for Payer: Kaiser Permanente Medicaid	$18,474.51
Rate for Payer: Ohana Health Plan Medicaid	$18,474.51
Rate for Payer: UnitedHealthcare Medicaid	$18,474.51

NEONATE BWT 2000-2499G W MAJOR ANOMALY

Facility

$6,716.84

Service Code	APR-DRG 6211
Min. Negotiated Rate	$6,716.84
Max. Negotiated Rate	$6,716.84
Rate for Payer: AlohaCare Medicaid	$6,716.84
Rate for Payer: Hawaii Medical Service Association ABD	$6,716.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,716.84
Rate for Payer: Kaiser Permanente Medicaid	$6,716.84
Rate for Payer: Ohana Health Plan Medicaid	$6,716.84
Rate for Payer: UnitedHealthcare Medicaid	$6,716.84

NEONATE BWT 2000-2499G W MAJOR ANOMALY

Facility

$36,799.99

Service Code	APR-DRG 6213
Min. Negotiated Rate	$36,799.99
Max. Negotiated Rate	$36,799.99
Rate for Payer: AlohaCare Medicaid	$36,799.99
Rate for Payer: Hawaii Medical Service Association ABD	$36,799.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36,799.99
Rate for Payer: Kaiser Permanente Medicaid	$36,799.99
Rate for Payer: Ohana Health Plan Medicaid	$36,799.99
Rate for Payer: UnitedHealthcare Medicaid	$36,799.99

NEONATE BWT 2000-2499G W MAJOR ANOMALY

Facility

$69,051.67

Service Code	APR-DRG 6214
Min. Negotiated Rate	$69,051.67
Max. Negotiated Rate	$69,051.67
Rate for Payer: AlohaCare Medicaid	$69,051.67
Rate for Payer: Hawaii Medical Service Association ABD	$69,051.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$69,051.67
Rate for Payer: Kaiser Permanente Medicaid	$69,051.67
Rate for Payer: Ohana Health Plan Medicaid	$69,051.67
Rate for Payer: UnitedHealthcare Medicaid	$69,051.67

NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION

Facility

$29,123.74

Service Code	APR-DRG 6254
Min. Negotiated Rate	$29,123.74
Max. Negotiated Rate	$29,123.74
Rate for Payer: AlohaCare Medicaid	$29,123.74
Rate for Payer: Hawaii Medical Service Association ABD	$29,123.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$29,123.74
Rate for Payer: Kaiser Permanente Medicaid	$29,123.74
Rate for Payer: Ohana Health Plan Medicaid	$29,123.74
Rate for Payer: UnitedHealthcare Medicaid	$29,123.74

NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION

Facility

$18,048.11

Service Code	APR-DRG 6252
Min. Negotiated Rate	$18,048.11
Max. Negotiated Rate	$18,048.11
Rate for Payer: AlohaCare Medicaid	$18,048.11
Rate for Payer: Hawaii Medical Service Association ABD	$18,048.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18,048.11
Rate for Payer: Kaiser Permanente Medicaid	$18,048.11
Rate for Payer: Ohana Health Plan Medicaid	$18,048.11
Rate for Payer: UnitedHealthcare Medicaid	$18,048.11

NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION

Facility

$26,380.74

Service Code	APR-DRG 6253
Min. Negotiated Rate	$26,380.74
Max. Negotiated Rate	$26,380.74
Rate for Payer: AlohaCare Medicaid	$26,380.74
Rate for Payer: Hawaii Medical Service Association ABD	$26,380.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26,380.74
Rate for Payer: Kaiser Permanente Medicaid	$26,380.74
Rate for Payer: Ohana Health Plan Medicaid	$26,380.74
Rate for Payer: UnitedHealthcare Medicaid	$26,380.74

NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION

Facility

$11,809.99

Service Code	APR-DRG 6251
Min. Negotiated Rate	$11,809.99
Max. Negotiated Rate	$11,809.99
Rate for Payer: AlohaCare Medicaid	$11,809.99
Rate for Payer: Hawaii Medical Service Association ABD	$11,809.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,809.99
Rate for Payer: Kaiser Permanente Medicaid	$11,809.99
Rate for Payer: Ohana Health Plan Medicaid	$11,809.99
Rate for Payer: UnitedHealthcare Medicaid	$11,809.99

NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$16,328.68

Service Code	APR-DRG 6221
Min. Negotiated Rate	$16,328.68
Max. Negotiated Rate	$16,328.68
Rate for Payer: AlohaCare Medicaid	$16,328.68
Rate for Payer: Hawaii Medical Service Association ABD	$16,328.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16,328.68
Rate for Payer: Kaiser Permanente Medicaid	$16,328.68
Rate for Payer: Ohana Health Plan Medicaid	$16,328.68
Rate for Payer: UnitedHealthcare Medicaid	$16,328.68

NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$22,026.89

Service Code	APR-DRG 6222
Min. Negotiated Rate	$22,026.89
Max. Negotiated Rate	$22,026.89
Rate for Payer: AlohaCare Medicaid	$22,026.89
Rate for Payer: Hawaii Medical Service Association ABD	$22,026.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22,026.89
Rate for Payer: Kaiser Permanente Medicaid	$22,026.89
Rate for Payer: Ohana Health Plan Medicaid	$22,026.89
Rate for Payer: UnitedHealthcare Medicaid	$22,026.89

NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$27,928.43

Service Code	APR-DRG 6223
Min. Negotiated Rate	$27,928.43
Max. Negotiated Rate	$27,928.43
Rate for Payer: AlohaCare Medicaid	$27,928.43
Rate for Payer: Hawaii Medical Service Association ABD	$27,928.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27,928.43
Rate for Payer: Kaiser Permanente Medicaid	$27,928.43
Rate for Payer: Ohana Health Plan Medicaid	$27,928.43
Rate for Payer: UnitedHealthcare Medicaid	$27,928.43

NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$47,804.55

Service Code	APR-DRG 6224
Min. Negotiated Rate	$47,804.55
Max. Negotiated Rate	$47,804.55
Rate for Payer: AlohaCare Medicaid	$47,804.55
Rate for Payer: Hawaii Medical Service Association ABD	$47,804.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$47,804.55
Rate for Payer: Kaiser Permanente Medicaid	$47,804.55
Rate for Payer: Ohana Health Plan Medicaid	$47,804.55
Rate for Payer: UnitedHealthcare Medicaid	$47,804.55

NEONATE BWT < 500G, OR BWT 500-999G & GESTATIONAL AGE <24 WKS, OR BWT 500-749G W MAJOR ANOMALY OR W/O LIFE SUSTAINING IN

Facility

$114,697.55

Service Code	APR-DRG 5893
Min. Negotiated Rate	$114,697.55
Max. Negotiated Rate	$114,697.55
Rate for Payer: AlohaCare Medicaid	$114,697.55
Rate for Payer: Hawaii Medical Service Association ABD	$114,697.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$114,697.55
Rate for Payer: Kaiser Permanente Medicaid	$114,697.55
Rate for Payer: Ohana Health Plan Medicaid	$114,697.55
Rate for Payer: UnitedHealthcare Medicaid	$114,697.55

NEONATE BWT < 500G, OR BWT 500-999G & GESTATIONAL AGE <24 WKS, OR BWT 500-749G W MAJOR ANOMALY OR W/O LIFE SUSTAINING IN

Facility

$120,432.28

Service Code	APR-DRG 5892
Min. Negotiated Rate	$120,432.28
Max. Negotiated Rate	$120,432.28
Rate for Payer: AlohaCare Medicaid	$120,432.28
Rate for Payer: Hawaii Medical Service Association ABD	$120,432.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$120,432.28
Rate for Payer: Kaiser Permanente Medicaid	$120,432.28
Rate for Payer: Ohana Health Plan Medicaid	$120,432.28
Rate for Payer: UnitedHealthcare Medicaid	$120,432.28

NEONATE BWT < 500G, OR BWT 500-999G & GESTATIONAL AGE <24 WKS, OR BWT 500-749G W MAJOR ANOMALY OR W/O LIFE SUSTAINING IN

Facility

$2,239.60

Service Code	APR-DRG 5894
Min. Negotiated Rate	$2,239.60
Max. Negotiated Rate	$2,239.60
Rate for Payer: AlohaCare Medicaid	$2,239.60
Rate for Payer: Hawaii Medical Service Association ABD	$2,239.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,239.60
Rate for Payer: Kaiser Permanente Medicaid	$2,239.60
Rate for Payer: Ohana Health Plan Medicaid	$2,239.60
Rate for Payer: UnitedHealthcare Medicaid	$2,239.60

NEONATE BWT < 500G, OR BWT 500-999G & GESTATIONAL AGE <24 WKS, OR BWT 500-749G W MAJOR ANOMALY OR W/O LIFE SUSTAINING IN

Facility

$126,454.24

Service Code	APR-DRG 5891
Min. Negotiated Rate	$126,454.24
Max. Negotiated Rate	$126,454.24
Rate for Payer: AlohaCare Medicaid	$126,454.24
Rate for Payer: Hawaii Medical Service Association ABD	$126,454.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$126,454.24
Rate for Payer: Kaiser Permanente Medicaid	$126,454.24
Rate for Payer: Ohana Health Plan Medicaid	$126,454.24
Rate for Payer: UnitedHealthcare Medicaid	$126,454.24

NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY

Facility

$65,522.83

Service Code	MSDRG 789
Min. Negotiated Rate	$23,703.92
Max. Negotiated Rate	$65,522.83
Rate for Payer: AlohaCare Medicare	$23,703.92
Rate for Payer: Devoted Health Medicare	$26,074.31
Rate for Payer: Hawaii Medical Service Association Commercial	$65,522.83
Rate for Payer: Hawaii Medical Service Association Medicare	$23,703.92
Rate for Payer: Humana Medicare	$23,703.92
Rate for Payer: Kaiser Permanente Commercial	$31,087.95
Rate for Payer: Kaiser Permanente Medicare	$23,703.92
Rate for Payer: Ohana Health Plan Medicare	$23,703.92
Rate for Payer: UnitedHealthcare Medicare	$23,703.92

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$4,396.30

Service Code	APR-DRG 5814
Min. Negotiated Rate	$4,396.30
Max. Negotiated Rate	$4,396.30
Rate for Payer: AlohaCare Medicaid	$4,396.30
Rate for Payer: Hawaii Medical Service Association ABD	$4,396.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,396.30
Rate for Payer: Kaiser Permanente Medicaid	$4,396.30
Rate for Payer: Ohana Health Plan Medicaid	$4,396.30
Rate for Payer: UnitedHealthcare Medicaid	$4,396.30

Know your out-of-pocket cost for care.

All Charges