Kona Community Hospital

All Charges

Charge

Type

Setting

Price

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$1,727.33

Service Code	APR-DRG 5812
Min. Negotiated Rate	$1,727.33
Max. Negotiated Rate	$1,727.33
Rate for Payer: AlohaCare Medicaid	$1,727.33
Rate for Payer: Hawaii Medical Service Association ABD	$1,727.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,727.33
Rate for Payer: Kaiser Permanente Medicaid	$1,727.33
Rate for Payer: Ohana Health Plan Medicaid	$1,727.33
Rate for Payer: UnitedHealthcare Medicaid	$1,727.33

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

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$1,445.03

Service Code	APR-DRG 5811
Min. Negotiated Rate	$1,445.03
Max. Negotiated Rate	$1,445.03
Rate for Payer: AlohaCare Medicaid	$1,445.03
Rate for Payer: Hawaii Medical Service Association ABD	$1,445.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,445.03
Rate for Payer: Kaiser Permanente Medicaid	$1,445.03
Rate for Payer: Ohana Health Plan Medicaid	$1,445.03
Rate for Payer: UnitedHealthcare Medicaid	$1,445.03

NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE

Facility

$3,559.28

Service Code	APR-DRG 5802
Min. Negotiated Rate	$3,559.28
Max. Negotiated Rate	$3,559.28
Rate for Payer: AlohaCare Medicaid	$3,559.28
Rate for Payer: Hawaii Medical Service Association ABD	$3,559.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,559.28
Rate for Payer: Kaiser Permanente Medicaid	$3,559.28
Rate for Payer: Ohana Health Plan Medicaid	$3,559.28
Rate for Payer: UnitedHealthcare Medicaid	$3,559.28

NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE

Facility

$5,614.31

Service Code	APR-DRG 5803
Min. Negotiated Rate	$5,614.31
Max. Negotiated Rate	$5,614.31
Rate for Payer: AlohaCare Medicaid	$5,614.31
Rate for Payer: Hawaii Medical Service Association ABD	$5,614.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,614.31
Rate for Payer: Kaiser Permanente Medicaid	$5,614.31
Rate for Payer: Ohana Health Plan Medicaid	$5,614.31
Rate for Payer: UnitedHealthcare Medicaid	$5,614.31

NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE

Facility

$2,485.38

Service Code	APR-DRG 5801
Min. Negotiated Rate	$2,485.38
Max. Negotiated Rate	$2,485.38
Rate for Payer: AlohaCare Medicaid	$2,485.38
Rate for Payer: Hawaii Medical Service Association ABD	$2,485.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,485.38
Rate for Payer: Kaiser Permanente Medicaid	$2,485.38
Rate for Payer: Ohana Health Plan Medicaid	$2,485.38
Rate for Payer: UnitedHealthcare Medicaid	$2,485.38

NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE

Facility

$9,783.59

Service Code	APR-DRG 5804
Min. Negotiated Rate	$9,783.59
Max. Negotiated Rate	$9,783.59
Rate for Payer: AlohaCare Medicaid	$9,783.59
Rate for Payer: Hawaii Medical Service Association ABD	$9,783.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,783.59
Rate for Payer: Kaiser Permanente Medicaid	$9,783.59
Rate for Payer: Ohana Health Plan Medicaid	$9,783.59
Rate for Payer: UnitedHealthcare Medicaid	$9,783.59

NEONATE W ECMO

Facility

$84,159.38

Service Code	APR-DRG 5831
Min. Negotiated Rate	$84,159.38
Max. Negotiated Rate	$84,159.38
Rate for Payer: AlohaCare Medicaid	$84,159.38
Rate for Payer: Hawaii Medical Service Association ABD	$84,159.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$84,159.38
Rate for Payer: Kaiser Permanente Medicaid	$84,159.38
Rate for Payer: Ohana Health Plan Medicaid	$84,159.38
Rate for Payer: UnitedHealthcare Medicaid	$84,159.38

NEONATE W ECMO

Facility

$229,647.78

Service Code	APR-DRG 5834
Min. Negotiated Rate	$229,647.78
Max. Negotiated Rate	$229,647.78
Rate for Payer: AlohaCare Medicaid	$229,647.78
Rate for Payer: Hawaii Medical Service Association ABD	$229,647.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$229,647.78
Rate for Payer: Kaiser Permanente Medicaid	$229,647.78
Rate for Payer: Ohana Health Plan Medicaid	$229,647.78
Rate for Payer: UnitedHealthcare Medicaid	$229,647.78

NEONATE W ECMO

Facility

$139,911.61

Service Code	APR-DRG 5833
Min. Negotiated Rate	$139,911.61
Max. Negotiated Rate	$139,911.61
Rate for Payer: AlohaCare Medicaid	$139,911.61
Rate for Payer: Hawaii Medical Service Association ABD	$139,911.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$139,911.61
Rate for Payer: Kaiser Permanente Medicaid	$139,911.61
Rate for Payer: Ohana Health Plan Medicaid	$139,911.61
Rate for Payer: UnitedHealthcare Medicaid	$139,911.61

NEONATE W ECMO

Facility

$132,893.72

Service Code	APR-DRG 5832
Min. Negotiated Rate	$132,893.72
Max. Negotiated Rate	$132,893.72
Rate for Payer: AlohaCare Medicaid	$132,893.72
Rate for Payer: Hawaii Medical Service Association ABD	$132,893.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$132,893.72
Rate for Payer: Kaiser Permanente Medicaid	$132,893.72
Rate for Payer: Ohana Health Plan Medicaid	$132,893.72
Rate for Payer: UnitedHealthcare Medicaid	$132,893.72

NEONATE WITH OTHER SIGNIFICANT PROBLEMS

Facility

$25,459.28

Service Code	MSDRG 794
Min. Negotiated Rate	$4,098.19
Max. Negotiated Rate	$25,459.28
Rate for Payer: AlohaCare Medicare	$19,412.16
Rate for Payer: Devoted Health Medicare	$21,353.38
Rate for Payer: Hawaii Medical Service Association Commercial	$4,098.19
Rate for Payer: Hawaii Medical Service Association Medicare	$19,412.16
Rate for Payer: Humana Medicare	$19,412.16
Rate for Payer: Kaiser Permanente Commercial	$25,459.28
Rate for Payer: Kaiser Permanente Medicare	$19,412.16
Rate for Payer: Ohana Health Plan Medicare	$19,412.16
Rate for Payer: UnitedHealthcare Medicare	$19,412.16

NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN

Facility

$53.13

Service Code	HCPCS J2710
Hospital Revenue Code	636
Min. Negotiated Rate	$27.10
Max. Negotiated Rate	$51.54
Rate for Payer: Cash Price	$34.53
Rate for Payer: Hawaii Western Management Group Commercial	$50.47
Rate for Payer: Health Management Network Commercial	$45.16
Rate for Payer: Kaiser Permanente Commercial	$33.47
Rate for Payer: Kaiser Permanente Medicaid	$27.10
Rate for Payer: MDX Hawaii PPO	$51.54
Rate for Payer: UnitedHealthcare Medicaid	$31.88
Rate for Payer: University Health Alliance Commercial	$38.73

NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN

Facility

$53.13

Service Code	HCPCS J2710
Hospital Revenue Code	250
Min. Negotiated Rate	$45.16
Max. Negotiated Rate	$51.54
Rate for Payer: Cash Price	$34.53
Rate for Payer: Health Management Network Commercial	$45.16
Rate for Payer: MDX Hawaii PPO	$51.54

NEPHRITIS & NEPHROSIS

Facility

$2,349.17

Service Code	APR-DRG 4621
Min. Negotiated Rate	$2,349.17
Max. Negotiated Rate	$2,349.17
Rate for Payer: AlohaCare Medicaid	$2,349.17
Rate for Payer: Hawaii Medical Service Association ABD	$2,349.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,349.17
Rate for Payer: Kaiser Permanente Medicaid	$2,349.17
Rate for Payer: Ohana Health Plan Medicaid	$2,349.17
Rate for Payer: UnitedHealthcare Medicaid	$2,349.17

NEPHRITIS & NEPHROSIS

Facility

$17,687.84

Service Code	APR-DRG 4624
Min. Negotiated Rate	$17,687.84
Max. Negotiated Rate	$17,687.84
Rate for Payer: AlohaCare Medicaid	$17,687.84
Rate for Payer: Hawaii Medical Service Association ABD	$17,687.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17,687.84
Rate for Payer: Kaiser Permanente Medicaid	$17,687.84
Rate for Payer: Ohana Health Plan Medicaid	$17,687.84
Rate for Payer: UnitedHealthcare Medicaid	$17,687.84

NEPHRITIS & NEPHROSIS

Facility

$6,155.34

Service Code	APR-DRG 4623
Min. Negotiated Rate	$6,155.34
Max. Negotiated Rate	$6,155.34
Rate for Payer: AlohaCare Medicaid	$6,155.34
Rate for Payer: Hawaii Medical Service Association ABD	$6,155.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,155.34
Rate for Payer: Kaiser Permanente Medicaid	$6,155.34
Rate for Payer: Ohana Health Plan Medicaid	$6,155.34
Rate for Payer: UnitedHealthcare Medicaid	$6,155.34

NEPHRITIS & NEPHROSIS

Facility

$3,219.68

Service Code	APR-DRG 4622
Min. Negotiated Rate	$3,219.68
Max. Negotiated Rate	$3,219.68
Rate for Payer: AlohaCare Medicaid	$3,219.68
Rate for Payer: Hawaii Medical Service Association ABD	$3,219.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,219.68
Rate for Payer: Kaiser Permanente Medicaid	$3,219.68
Rate for Payer: Ohana Health Plan Medicaid	$3,219.68
Rate for Payer: UnitedHealthcare Medicaid	$3,219.68

NERVOUS SYSTEM MALIGNANCY

Facility

$7,907.82

Service Code	APR-DRG 0414
Min. Negotiated Rate	$7,907.82
Max. Negotiated Rate	$7,907.82
Rate for Payer: AlohaCare Medicaid	$7,907.82
Rate for Payer: Hawaii Medical Service Association ABD	$7,907.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,907.82
Rate for Payer: Kaiser Permanente Medicaid	$7,907.82
Rate for Payer: Ohana Health Plan Medicaid	$7,907.82
Rate for Payer: UnitedHealthcare Medicaid	$7,907.82

NERVOUS SYSTEM MALIGNANCY

Facility

$3,643.79

Service Code	APR-DRG 0411
Min. Negotiated Rate	$3,643.79
Max. Negotiated Rate	$3,643.79
Rate for Payer: AlohaCare Medicaid	$3,643.79
Rate for Payer: Hawaii Medical Service Association ABD	$3,643.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,643.79
Rate for Payer: Kaiser Permanente Medicaid	$3,643.79
Rate for Payer: Ohana Health Plan Medicaid	$3,643.79
Rate for Payer: UnitedHealthcare Medicaid	$3,643.79

NERVOUS SYSTEM MALIGNANCY

Facility

$4,041.15

Service Code	APR-DRG 0412
Min. Negotiated Rate	$4,041.15
Max. Negotiated Rate	$4,041.15
Rate for Payer: AlohaCare Medicaid	$4,041.15
Rate for Payer: Hawaii Medical Service Association ABD	$4,041.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,041.15
Rate for Payer: Kaiser Permanente Medicaid	$4,041.15
Rate for Payer: Ohana Health Plan Medicaid	$4,041.15
Rate for Payer: UnitedHealthcare Medicaid	$4,041.15

NERVOUS SYSTEM MALIGNANCY

Facility

$5,284.83

Service Code	APR-DRG 0413
Min. Negotiated Rate	$5,284.83
Max. Negotiated Rate	$5,284.83
Rate for Payer: AlohaCare Medicaid	$5,284.83
Rate for Payer: Hawaii Medical Service Association ABD	$5,284.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,284.83
Rate for Payer: Kaiser Permanente Medicaid	$5,284.83
Rate for Payer: Ohana Health Plan Medicaid	$5,284.83
Rate for Payer: UnitedHealthcare Medicaid	$5,284.83

NERVOUS SYSTEM NEOPLASMS WITH MCC

Facility

$26,339.03

Service Code	MSDRG 054
Min. Negotiated Rate	$20,082.95
Max. Negotiated Rate	$26,339.03
Rate for Payer: AlohaCare Medicare	$20,082.95
Rate for Payer: Devoted Health Medicare	$22,091.24
Rate for Payer: Hawaii Medical Service Association Commercial	$24,323.96
Rate for Payer: Hawaii Medical Service Association Medicare	$20,082.95
Rate for Payer: Humana Medicare	$20,082.95
Rate for Payer: Kaiser Permanente Commercial	$26,339.03
Rate for Payer: Kaiser Permanente Medicare	$20,082.95
Rate for Payer: Ohana Health Plan Medicare	$20,082.95
Rate for Payer: UnitedHealthcare Medicare	$20,082.95

NERVOUS SYSTEM NEOPLASMS WITHOUT MCC

Facility

$24,082.89

Service Code	MSDRG 055
Min. Negotiated Rate	$13,410.57
Max. Negotiated Rate	$24,082.89
Rate for Payer: AlohaCare Medicare	$13,410.57
Rate for Payer: Devoted Health Medicare	$14,751.63
Rate for Payer: Hawaii Medical Service Association Commercial	$24,082.89
Rate for Payer: Hawaii Medical Service Association Medicare	$13,410.57
Rate for Payer: Humana Medicare	$13,410.57
Rate for Payer: Kaiser Permanente Commercial	$17,588.10
Rate for Payer: Kaiser Permanente Medicare	$13,410.57
Rate for Payer: Ohana Health Plan Medicare	$13,410.57
Rate for Payer: UnitedHealthcare Medicare	$13,410.57

NEUROLOGICAL EYE DISORDERS

Facility

$16,923.11

Service Code	MSDRG 123
Min. Negotiated Rate	$10,503.79
Max. Negotiated Rate	$16,923.11
Rate for Payer: AlohaCare Medicare	$10,503.79
Rate for Payer: Devoted Health Medicare	$11,554.17
Rate for Payer: Hawaii Medical Service Association Commercial	$16,923.11
Rate for Payer: Hawaii Medical Service Association Medicare	$10,503.79
Rate for Payer: Humana Medicare	$10,503.79
Rate for Payer: Kaiser Permanente Commercial	$13,775.85
Rate for Payer: Kaiser Permanente Medicare	$10,503.79
Rate for Payer: Ohana Health Plan Medicare	$10,503.79
Rate for Payer: UnitedHealthcare Medicare	$10,503.79

Know your out-of-pocket cost for care.

All Charges