Kona Community Hospital

All Charges

Charge

Type

Setting

Price

NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$19,312.32

Service Code	APR-DRG 9524
Min. Negotiated Rate	$19,312.32
Max. Negotiated Rate	$19,312.32
Rate for Payer: AlohaCare Medicaid	$19,312.32
Rate for Payer: Hawaii Medical Service Association ABD	$19,312.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19,312.32
Rate for Payer: Kaiser Permanente Medicaid	$19,312.32
Rate for Payer: Ohana Health Plan Medicaid	$19,312.32
Rate for Payer: UnitedHealthcare Medicaid	$19,312.32

NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$10,190.12

Service Code	APR-DRG 9523
Min. Negotiated Rate	$10,190.12
Max. Negotiated Rate	$10,190.12
Rate for Payer: AlohaCare Medicaid	$10,190.12
Rate for Payer: Hawaii Medical Service Association ABD	$10,190.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,190.12
Rate for Payer: Kaiser Permanente Medicaid	$10,190.12
Rate for Payer: Ohana Health Plan Medicaid	$10,190.12
Rate for Payer: UnitedHealthcare Medicaid	$10,190.12

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$4,504.11

Service Code	APR-DRG 4263
Min. Negotiated Rate	$4,504.11
Max. Negotiated Rate	$4,504.11
Rate for Payer: AlohaCare Medicaid	$4,504.11
Rate for Payer: Hawaii Medical Service Association ABD	$4,504.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,504.11
Rate for Payer: Kaiser Permanente Medicaid	$4,504.11
Rate for Payer: Ohana Health Plan Medicaid	$4,504.11
Rate for Payer: UnitedHealthcare Medicaid	$4,504.11

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$2,414.12

Service Code	APR-DRG 4261
Min. Negotiated Rate	$2,414.12
Max. Negotiated Rate	$2,414.12
Rate for Payer: AlohaCare Medicaid	$2,414.12
Rate for Payer: Hawaii Medical Service Association ABD	$2,414.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,414.12
Rate for Payer: Kaiser Permanente Medicaid	$2,414.12
Rate for Payer: Ohana Health Plan Medicaid	$2,414.12
Rate for Payer: UnitedHealthcare Medicaid	$2,414.12

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$8,251.06

Service Code	APR-DRG 4264
Min. Negotiated Rate	$8,251.06
Max. Negotiated Rate	$8,251.06
Rate for Payer: AlohaCare Medicaid	$8,251.06
Rate for Payer: Hawaii Medical Service Association ABD	$8,251.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,251.06
Rate for Payer: Kaiser Permanente Medicaid	$8,251.06
Rate for Payer: Ohana Health Plan Medicaid	$8,251.06
Rate for Payer: UnitedHealthcare Medicaid	$8,251.06

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$3,124.16

Service Code	APR-DRG 4262
Min. Negotiated Rate	$3,124.16
Max. Negotiated Rate	$3,124.16
Rate for Payer: AlohaCare Medicaid	$3,124.16
Rate for Payer: Hawaii Medical Service Association ABD	$3,124.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,124.16
Rate for Payer: Kaiser Permanente Medicaid	$3,124.16
Rate for Payer: Ohana Health Plan Medicaid	$3,124.16
Rate for Payer: UnitedHealthcare Medicaid	$3,124.16

NON-MALIGNANT BREAST DISORDERS WITH CC/MCC

Facility

$17,967.60

Service Code	MSDRG 600
Min. Negotiated Rate	$13,699.92
Max. Negotiated Rate	$17,967.60
Rate for Payer: AlohaCare Medicare	$13,699.92
Rate for Payer: Devoted Health Medicare	$15,069.91
Rate for Payer: Hawaii Medical Service Association Commercial	$16,272.23
Rate for Payer: Hawaii Medical Service Association Medicare	$13,699.92
Rate for Payer: Humana Medicare	$13,699.92
Rate for Payer: Kaiser Permanente Commercial	$17,967.60
Rate for Payer: Kaiser Permanente Medicare	$13,699.92
Rate for Payer: Ohana Health Plan Medicare	$13,699.92
Rate for Payer: UnitedHealthcare Medicare	$13,699.92

NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$16,272.23

Service Code	MSDRG 601
Min. Negotiated Rate	$7,957.42
Max. Negotiated Rate	$16,272.23
Rate for Payer: AlohaCare Medicare	$7,957.42
Rate for Payer: Devoted Health Medicare	$8,753.16
Rate for Payer: Hawaii Medical Service Association Commercial	$16,272.23
Rate for Payer: Hawaii Medical Service Association Medicare	$7,957.42
Rate for Payer: Humana Medicare	$7,957.42
Rate for Payer: Kaiser Permanente Commercial	$10,436.25
Rate for Payer: Kaiser Permanente Medicare	$7,957.42
Rate for Payer: Ohana Health Plan Medicare	$7,957.42
Rate for Payer: UnitedHealthcare Medicare	$7,957.42

NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT

Facility

$5,311.57

Service Code	APR-DRG 0463
Min. Negotiated Rate	$5,311.57
Max. Negotiated Rate	$5,311.57
Rate for Payer: AlohaCare Medicaid	$5,311.57
Rate for Payer: Hawaii Medical Service Association ABD	$5,311.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,311.57
Rate for Payer: Kaiser Permanente Medicaid	$5,311.57
Rate for Payer: Ohana Health Plan Medicaid	$5,311.57
Rate for Payer: UnitedHealthcare Medicaid	$5,311.57

NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT

Facility

$9,579.43

Service Code	APR-DRG 0464
Min. Negotiated Rate	$9,579.43
Max. Negotiated Rate	$9,579.43
Rate for Payer: AlohaCare Medicaid	$9,579.43
Rate for Payer: Hawaii Medical Service Association ABD	$9,579.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,579.43
Rate for Payer: Kaiser Permanente Medicaid	$9,579.43
Rate for Payer: Ohana Health Plan Medicaid	$9,579.43
Rate for Payer: UnitedHealthcare Medicaid	$9,579.43

NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT

Facility

$4,138.58

Service Code	APR-DRG 0462
Min. Negotiated Rate	$4,138.58
Max. Negotiated Rate	$4,138.58
Rate for Payer: AlohaCare Medicaid	$4,138.58
Rate for Payer: Hawaii Medical Service Association ABD	$4,138.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,138.58
Rate for Payer: Kaiser Permanente Medicaid	$4,138.58
Rate for Payer: Ohana Health Plan Medicaid	$4,138.58
Rate for Payer: UnitedHealthcare Medicaid	$4,138.58

NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT

Facility

$3,405.62

Service Code	APR-DRG 0461
Min. Negotiated Rate	$3,405.62
Max. Negotiated Rate	$3,405.62
Rate for Payer: AlohaCare Medicaid	$3,405.62
Rate for Payer: Hawaii Medical Service Association ABD	$3,405.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,405.62
Rate for Payer: Kaiser Permanente Medicaid	$3,405.62
Rate for Payer: Ohana Health Plan Medicaid	$3,405.62
Rate for Payer: UnitedHealthcare Medicaid	$3,405.62

NONTRAUMATIC STUPOR AND COMA WITH MCC

Facility

$33,123.02

Service Code	MSDRG 080
Min. Negotiated Rate	$23,806.50
Max. Negotiated Rate	$33,123.02
Rate for Payer: AlohaCare Medicare	$23,806.50
Rate for Payer: Devoted Health Medicare	$26,187.15
Rate for Payer: Hawaii Medical Service Association Commercial	$33,123.02
Rate for Payer: Hawaii Medical Service Association Medicare	$23,806.50
Rate for Payer: Humana Medicare	$23,806.50
Rate for Payer: Kaiser Permanente Commercial	$31,222.50
Rate for Payer: Kaiser Permanente Medicare	$23,806.50
Rate for Payer: Ohana Health Plan Medicare	$23,806.50
Rate for Payer: UnitedHealthcare Medicare	$23,806.50

NONTRAUMATIC STUPOR AND COMA WITHOUT MCC

Facility

$33,123.02

Service Code	MSDRG 081
Min. Negotiated Rate	$11,779.60
Max. Negotiated Rate	$33,123.02
Rate for Payer: AlohaCare Medicare	$11,779.60
Rate for Payer: Devoted Health Medicare	$12,957.56
Rate for Payer: Hawaii Medical Service Association Commercial	$33,123.02
Rate for Payer: Hawaii Medical Service Association Medicare	$11,779.60
Rate for Payer: Humana Medicare	$11,779.60
Rate for Payer: Kaiser Permanente Commercial	$15,449.10
Rate for Payer: Kaiser Permanente Medicare	$11,779.60
Rate for Payer: Ohana Health Plan Medicare	$11,779.60
Rate for Payer: UnitedHealthcare Medicare	$11,779.60

NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN

Facility

$108.36

Service Code	NDC 67457085200
Hospital Revenue Code	250
Min. Negotiated Rate	$92.11
Max. Negotiated Rate	$105.11
Rate for Payer: Cash Price	$70.43
Rate for Payer: Health Management Network Commercial	$92.11
Rate for Payer: MDX Hawaii PPO	$105.11

NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN

Facility

$108.36

Service Code	NDC 67457085204
Hospital Revenue Code	250
Min. Negotiated Rate	$92.11
Max. Negotiated Rate	$105.11
Rate for Payer: Cash Price	$70.43
Rate for Payer: Health Management Network Commercial	$92.11
Rate for Payer: MDX Hawaii PPO	$105.11

NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN

Facility

$108.36

Service Code	NDC 67457085200
Hospital Revenue Code	250
Min. Negotiated Rate	$55.26
Max. Negotiated Rate	$105.11
Rate for Payer: Cash Price	$70.43
Rate for Payer: Hawaii Western Management Group Commercial	$102.94
Rate for Payer: Health Management Network Commercial	$92.11
Rate for Payer: Kaiser Permanente Commercial	$68.27
Rate for Payer: Kaiser Permanente Medicaid	$55.26
Rate for Payer: MDX Hawaii PPO	$105.11
Rate for Payer: UnitedHealthcare Medicaid	$65.02
Rate for Payer: University Health Alliance Commercial	$78.98

NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN

Facility

$108.36

Service Code	NDC 67457085204
Hospital Revenue Code	250
Min. Negotiated Rate	$55.26
Max. Negotiated Rate	$105.11
Rate for Payer: Cash Price	$70.43
Rate for Payer: Hawaii Western Management Group Commercial	$102.94
Rate for Payer: Health Management Network Commercial	$92.11
Rate for Payer: Kaiser Permanente Commercial	$68.27
Rate for Payer: Kaiser Permanente Medicaid	$55.26
Rate for Payer: MDX Hawaii PPO	$105.11
Rate for Payer: UnitedHealthcare Medicaid	$65.02
Rate for Payer: University Health Alliance Commercial	$78.98

NOREPINEPHRINE BITARTRATE-D5W 4 MG/250 ML (16 MCG/ML) IV SOLN

Facility

$111.15

Service Code	NDC 00338011220
Hospital Revenue Code	250
Min. Negotiated Rate	$56.69
Max. Negotiated Rate	$107.82
Rate for Payer: Cash Price	$72.25
Rate for Payer: Hawaii Western Management Group Commercial	$105.59
Rate for Payer: Health Management Network Commercial	$94.48
Rate for Payer: Kaiser Permanente Commercial	$70.02
Rate for Payer: Kaiser Permanente Medicaid	$56.69
Rate for Payer: MDX Hawaii PPO	$107.82
Rate for Payer: UnitedHealthcare Medicaid	$66.69
Rate for Payer: University Health Alliance Commercial	$81.02

NOREPINEPHRINE BITARTRATE-D5W 4 MG/250 ML (16 MCG/ML) IV SOLN

Facility

$111.15

Service Code	NDC 00338011220
Hospital Revenue Code	250
Min. Negotiated Rate	$94.48
Max. Negotiated Rate	$107.82
Rate for Payer: Cash Price	$72.25
Rate for Payer: Health Management Network Commercial	$94.48
Rate for Payer: MDX Hawaii PPO	$107.82

NOREPINEPHRINE BITARTRATE-NACL 16 MG/250 ML (64 MCG/ML) IV SOLN

Facility

$427.06

Service Code	NDC 44567064210
Hospital Revenue Code	250
Min. Negotiated Rate	$363.00
Max. Negotiated Rate	$414.25
Rate for Payer: Cash Price	$277.59
Rate for Payer: Health Management Network Commercial	$363.00
Rate for Payer: MDX Hawaii PPO	$414.25

NOREPINEPHRINE BITARTRATE-NACL 16 MG/250 ML (64 MCG/ML) IV SOLN

Facility

$427.06

Service Code	NDC 44567064201
Hospital Revenue Code	250
Min. Negotiated Rate	$363.00
Max. Negotiated Rate	$414.25
Rate for Payer: Cash Price	$277.59
Rate for Payer: Health Management Network Commercial	$363.00
Rate for Payer: MDX Hawaii PPO	$414.25

NOREPINEPHRINE BITARTRATE-NACL 16 MG/250 ML (64 MCG/ML) IV SOLN

Facility

$427.06

Service Code	NDC 44567064201
Hospital Revenue Code	250
Min. Negotiated Rate	$217.80
Max. Negotiated Rate	$414.25
Rate for Payer: Cash Price	$277.59
Rate for Payer: Hawaii Western Management Group Commercial	$405.71
Rate for Payer: Health Management Network Commercial	$363.00
Rate for Payer: Kaiser Permanente Commercial	$269.05
Rate for Payer: Kaiser Permanente Medicaid	$217.80
Rate for Payer: MDX Hawaii PPO	$414.25
Rate for Payer: UnitedHealthcare Medicaid	$256.24
Rate for Payer: University Health Alliance Commercial	$311.28

NOREPINEPHRINE BITARTRATE-NACL 16 MG/250 ML (64 MCG/ML) IV SOLN

Facility

$427.06

Service Code	NDC 44567064210
Hospital Revenue Code	250
Min. Negotiated Rate	$217.80
Max. Negotiated Rate	$414.25
Rate for Payer: Cash Price	$277.59
Rate for Payer: Hawaii Western Management Group Commercial	$405.71
Rate for Payer: Health Management Network Commercial	$363.00
Rate for Payer: Kaiser Permanente Commercial	$269.05
Rate for Payer: Kaiser Permanente Medicaid	$217.80
Rate for Payer: MDX Hawaii PPO	$414.25
Rate for Payer: UnitedHealthcare Medicaid	$256.24
Rate for Payer: University Health Alliance Commercial	$311.28

NORFLURANE-PENTAFLUOROPROPANE TOP AERO.SPRAY

Facility

$162.08

Service Code	NDC 00386000803
Hospital Revenue Code	250
Min. Negotiated Rate	$82.66
Max. Negotiated Rate	$157.22
Rate for Payer: Cash Price	$105.35
Rate for Payer: Hawaii Western Management Group Commercial	$153.98
Rate for Payer: Health Management Network Commercial	$137.77
Rate for Payer: Kaiser Permanente Commercial	$102.11
Rate for Payer: Kaiser Permanente Medicaid	$82.66
Rate for Payer: MDX Hawaii PPO	$157.22
Rate for Payer: UnitedHealthcare Medicaid	$97.25
Rate for Payer: University Health Alliance Commercial	$118.14

Know your out-of-pocket cost for care.

All Charges