Kona Community Hospital

All Charges

Charge

Type

Setting

Price

OSTEOPLASTY, HUMERUS (EG, SHORTENING OR LENGTHENING) (EXCLUDING 64876)

Facility

$10,715.11

Service Code	CPT 24420
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$10,715.11
Rate for Payer: AlohaCare Medicaid	$8,572.09
Rate for Payer: AlohaCare Medicare	$8,572.09
Rate for Payer: Devoted Health Medicare	$9,429.30
Rate for Payer: Hawaii Medical Service Association Commercial	$10,715.11
Rate for Payer: Hawaii Medical Service Association Medicare	$8,572.09
Rate for Payer: Humana Medicare	$8,572.09
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$8,572.09
Rate for Payer: Ohana Health Plan Medicaid	$9,429.30
Rate for Payer: Ohana Health Plan Medicare	$8,572.09
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$8,572.09
Rate for Payer: University Health Alliance Commercial	$6,743.44

OSTEOTOMY; CALCANEUS (EG, DWYER OR CHAMBERS TYPE PROCEDURE), WITH OR WITHOUT INTERNAL FIXATION

Facility

$9,429.30

Service Code	CPT 28300
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$9,429.30
Rate for Payer: AlohaCare Medicaid	$8,572.09
Rate for Payer: AlohaCare Medicare	$8,572.09
Rate for Payer: Devoted Health Medicare	$9,429.30
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$9,416.00
Rate for Payer: Hawaii Medical Service Association Medicare	$8,572.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Humana Medicare	$8,572.09
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$8,572.09
Rate for Payer: Ohana Health Plan Medicaid	$9,429.30
Rate for Payer: Ohana Health Plan Medicare	$8,572.09
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$8,572.09
Rate for Payer: University Health Alliance Commercial	$5,160.40

OSTEOTOMY, CLAVICLE, WITH OR WITHOUT INTERNAL FIXATION; WITH BONE GRAFT FOR NONUNION OR MALUNION (INCLUDES OBTAINING GRAFT AND/OR NECESSARY FIXATION)

Facility

$16,700.00

Service Code	CPT 23485
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$16,700.00
Rate for Payer: AlohaCare Medicaid	$15,166.91
Rate for Payer: AlohaCare Medicare	$15,166.91
Rate for Payer: Devoted Health Medicare	$16,683.60
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$9,416.00
Rate for Payer: Hawaii Medical Service Association Medicare	$15,166.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Humana Medicare	$15,166.91
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$15,166.91
Rate for Payer: Ohana Health Plan Medicaid	$16,683.60
Rate for Payer: Ohana Health Plan Medicare	$15,166.91
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$15,166.91
Rate for Payer: University Health Alliance Commercial	$16,700.00

OTHER AFTERCARE & CONVALESCENCE

Facility

$4,258.30

Service Code	APR-DRG 8622
Min. Negotiated Rate	$4,258.30
Max. Negotiated Rate	$4,258.30
Rate for Payer: AlohaCare Medicaid	$4,258.30
Rate for Payer: Hawaii Medical Service Association ABD	$4,258.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,258.30
Rate for Payer: Kaiser Permanente Medicaid	$4,258.30
Rate for Payer: Ohana Health Plan Medicaid	$4,258.30
Rate for Payer: UnitedHealthcare Medicaid	$4,258.30

OTHER AFTERCARE & CONVALESCENCE

Facility

$7,483.71

Service Code	APR-DRG 8624
Min. Negotiated Rate	$7,483.71
Max. Negotiated Rate	$7,483.71
Rate for Payer: AlohaCare Medicaid	$7,483.71
Rate for Payer: Hawaii Medical Service Association ABD	$7,483.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,483.71
Rate for Payer: Kaiser Permanente Medicaid	$7,483.71
Rate for Payer: Ohana Health Plan Medicaid	$7,483.71
Rate for Payer: UnitedHealthcare Medicaid	$7,483.71

OTHER AFTERCARE & CONVALESCENCE

Facility

$3,422.82

Service Code	APR-DRG 8621
Min. Negotiated Rate	$3,422.82
Max. Negotiated Rate	$3,422.82
Rate for Payer: AlohaCare Medicaid	$3,422.82
Rate for Payer: Hawaii Medical Service Association ABD	$3,422.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,422.82
Rate for Payer: Kaiser Permanente Medicaid	$3,422.82
Rate for Payer: Ohana Health Plan Medicaid	$3,422.82
Rate for Payer: UnitedHealthcare Medicaid	$3,422.82

OTHER AFTERCARE & CONVALESCENCE

Facility

$5,774.53

Service Code	APR-DRG 8623
Min. Negotiated Rate	$5,774.53
Max. Negotiated Rate	$5,774.53
Rate for Payer: AlohaCare Medicaid	$5,774.53
Rate for Payer: Hawaii Medical Service Association ABD	$5,774.53
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,774.53
Rate for Payer: Kaiser Permanente Medicaid	$5,774.53
Rate for Payer: Ohana Health Plan Medicaid	$5,774.53
Rate for Payer: UnitedHealthcare Medicaid	$5,774.53

OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS

Facility

$3,472.49

Service Code	APR-DRG 6632
Min. Negotiated Rate	$3,472.49
Max. Negotiated Rate	$3,472.49
Rate for Payer: AlohaCare Medicaid	$3,472.49
Rate for Payer: Hawaii Medical Service Association ABD	$3,472.49
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,472.49
Rate for Payer: Kaiser Permanente Medicaid	$3,472.49
Rate for Payer: Ohana Health Plan Medicaid	$3,472.49
Rate for Payer: UnitedHealthcare Medicaid	$3,472.49

OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS

Facility

$4,805.95

Service Code	APR-DRG 6633
Min. Negotiated Rate	$4,805.95
Max. Negotiated Rate	$4,805.95
Rate for Payer: AlohaCare Medicaid	$4,805.95
Rate for Payer: Hawaii Medical Service Association ABD	$4,805.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,805.95
Rate for Payer: Kaiser Permanente Medicaid	$4,805.95
Rate for Payer: Ohana Health Plan Medicaid	$4,805.95
Rate for Payer: UnitedHealthcare Medicaid	$4,805.95

OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS

Facility

$2,685.40

Service Code	APR-DRG 6631
Min. Negotiated Rate	$2,685.40
Max. Negotiated Rate	$2,685.40
Rate for Payer: AlohaCare Medicaid	$2,685.40
Rate for Payer: Hawaii Medical Service Association ABD	$2,685.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,685.40
Rate for Payer: Kaiser Permanente Medicaid	$2,685.40
Rate for Payer: Ohana Health Plan Medicaid	$2,685.40
Rate for Payer: UnitedHealthcare Medicaid	$2,685.40

OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS

Facility

$7,895.72

Service Code	APR-DRG 6634
Min. Negotiated Rate	$7,895.72
Max. Negotiated Rate	$7,895.72
Rate for Payer: AlohaCare Medicaid	$7,895.72
Rate for Payer: Hawaii Medical Service Association ABD	$7,895.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,895.72
Rate for Payer: Kaiser Permanente Medicaid	$7,895.72
Rate for Payer: Ohana Health Plan Medicaid	$7,895.72
Rate for Payer: UnitedHealthcare Medicaid	$7,895.72

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC

Facility

$18,184.95

Service Code	MSDRG 818
Min. Negotiated Rate	$10,799.94
Max. Negotiated Rate	$18,184.95
Rate for Payer: AlohaCare Medicare	$15,246.70
Rate for Payer: Devoted Health Medicare	$16,771.37
Rate for Payer: Hawaii Medical Service Association Commercial	$10,799.94
Rate for Payer: Hawaii Medical Service Association Medicare	$15,246.70
Rate for Payer: Humana Medicare	$15,246.70
Rate for Payer: Kaiser Permanente Commercial	$18,184.95
Rate for Payer: Kaiser Permanente Medicare	$15,246.70
Rate for Payer: Ohana Health Plan Medicare	$15,246.70
Rate for Payer: UnitedHealthcare Medicare	$15,246.70

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC

Facility

$33,010.29

Service Code	MSDRG 817
Min. Negotiated Rate	$10,799.94
Max. Negotiated Rate	$33,010.29
Rate for Payer: AlohaCare Medicare	$30,009.35
Rate for Payer: Devoted Health Medicare	$33,010.29
Rate for Payer: Hawaii Medical Service Association Commercial	$10,799.94
Rate for Payer: Hawaii Medical Service Association Medicare	$30,009.35
Rate for Payer: Humana Medicare	$30,009.35
Rate for Payer: Kaiser Permanente Commercial	$29,118.00
Rate for Payer: Kaiser Permanente Medicare	$30,009.35
Rate for Payer: Ohana Health Plan Medicare	$30,009.35
Rate for Payer: UnitedHealthcare Medicare	$30,009.35

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$14,833.27

Service Code	MSDRG 819
Min. Negotiated Rate	$10,510.65
Max. Negotiated Rate	$14,833.27
Rate for Payer: AlohaCare Medicare	$11,310.06
Rate for Payer: Devoted Health Medicare	$12,441.07
Rate for Payer: Hawaii Medical Service Association Commercial	$10,510.65
Rate for Payer: Hawaii Medical Service Association Medicare	$11,310.06
Rate for Payer: Humana Medicare	$11,310.06
Rate for Payer: Kaiser Permanente Commercial	$14,833.27
Rate for Payer: Kaiser Permanente Medicare	$11,310.06
Rate for Payer: Ohana Health Plan Medicare	$11,310.06
Rate for Payer: UnitedHealthcare Medicare	$11,310.06

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC

Facility

$12,447.60

Service Code	MSDRG 832
Min. Negotiated Rate	$9,474.05
Max. Negotiated Rate	$12,447.60
Rate for Payer: AlohaCare Medicare	$9,491.04
Rate for Payer: Devoted Health Medicare	$10,440.14
Rate for Payer: Hawaii Medical Service Association Commercial	$9,474.05
Rate for Payer: Hawaii Medical Service Association Medicare	$9,491.04
Rate for Payer: Humana Medicare	$9,491.04
Rate for Payer: Kaiser Permanente Commercial	$12,447.60
Rate for Payer: Kaiser Permanente Medicare	$9,491.04
Rate for Payer: Ohana Health Plan Medicare	$9,491.04
Rate for Payer: UnitedHealthcare Medicare	$9,491.04

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC

Facility

$20,743.12

Service Code	MSDRG 831
Min. Negotiated Rate	$9,474.05
Max. Negotiated Rate	$20,743.12
Rate for Payer: AlohaCare Medicare	$15,816.20
Rate for Payer: Devoted Health Medicare	$17,397.82
Rate for Payer: Hawaii Medical Service Association Commercial	$9,474.05
Rate for Payer: Hawaii Medical Service Association Medicare	$15,816.20
Rate for Payer: Humana Medicare	$15,816.20
Rate for Payer: Kaiser Permanente Commercial	$20,743.12
Rate for Payer: Kaiser Permanente Medicare	$15,816.20
Rate for Payer: Ohana Health Plan Medicare	$15,816.20
Rate for Payer: UnitedHealthcare Medicare	$15,816.20

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$9,329.41

Service Code	MSDRG 833
Min. Negotiated Rate	$6,877.59
Max. Negotiated Rate	$9,329.41
Rate for Payer: AlohaCare Medicare	$6,877.59
Rate for Payer: Devoted Health Medicare	$7,565.35
Rate for Payer: Hawaii Medical Service Association Commercial	$9,329.41
Rate for Payer: Hawaii Medical Service Association Medicare	$6,877.59
Rate for Payer: Humana Medicare	$6,877.59
Rate for Payer: Kaiser Permanente Commercial	$9,020.02
Rate for Payer: Kaiser Permanente Medicare	$6,877.59
Rate for Payer: Ohana Health Plan Medicare	$6,877.59
Rate for Payer: UnitedHealthcare Medicare	$6,877.59

OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES

Facility

$3,717.02

Service Code	APR-DRG 3472
Min. Negotiated Rate	$3,717.02
Max. Negotiated Rate	$3,717.02
Rate for Payer: AlohaCare Medicaid	$3,717.02
Rate for Payer: Hawaii Medical Service Association ABD	$3,717.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,717.02
Rate for Payer: Kaiser Permanente Medicaid	$3,717.02
Rate for Payer: Ohana Health Plan Medicaid	$3,717.02
Rate for Payer: UnitedHealthcare Medicaid	$3,717.02

OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES

Facility

$3,068.12

Service Code	APR-DRG 3471
Min. Negotiated Rate	$3,068.12
Max. Negotiated Rate	$3,068.12
Rate for Payer: AlohaCare Medicaid	$3,068.12
Rate for Payer: Hawaii Medical Service Association ABD	$3,068.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,068.12
Rate for Payer: Kaiser Permanente Medicaid	$3,068.12
Rate for Payer: Ohana Health Plan Medicaid	$3,068.12
Rate for Payer: UnitedHealthcare Medicaid	$3,068.12

OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES

Facility

$4,904.66

Service Code	APR-DRG 3473
Min. Negotiated Rate	$4,904.66
Max. Negotiated Rate	$4,904.66
Rate for Payer: AlohaCare Medicaid	$4,904.66
Rate for Payer: Hawaii Medical Service Association ABD	$4,904.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,904.66
Rate for Payer: Kaiser Permanente Medicaid	$4,904.66
Rate for Payer: Ohana Health Plan Medicaid	$4,904.66
Rate for Payer: UnitedHealthcare Medicaid	$4,904.66

OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES

Facility

$9,262.30

Service Code	APR-DRG 3474
Min. Negotiated Rate	$9,262.30
Max. Negotiated Rate	$9,262.30
Rate for Payer: AlohaCare Medicaid	$9,262.30
Rate for Payer: Hawaii Medical Service Association ABD	$9,262.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,262.30
Rate for Payer: Kaiser Permanente Medicaid	$9,262.30
Rate for Payer: Ohana Health Plan Medicaid	$9,262.30
Rate for Payer: UnitedHealthcare Medicaid	$9,262.30

OTHER BLADDER PROCEDURES

Facility

$4,935.86

Service Code	APR-DRG 4451
Min. Negotiated Rate	$4,935.86
Max. Negotiated Rate	$4,935.86
Rate for Payer: AlohaCare Medicaid	$4,935.86
Rate for Payer: Hawaii Medical Service Association ABD	$4,935.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,935.86
Rate for Payer: Kaiser Permanente Medicaid	$4,935.86
Rate for Payer: Ohana Health Plan Medicaid	$4,935.86
Rate for Payer: UnitedHealthcare Medicaid	$4,935.86

OTHER BLADDER PROCEDURES

Facility

$6,387.13

Service Code	APR-DRG 4452
Min. Negotiated Rate	$6,387.13
Max. Negotiated Rate	$6,387.13
Rate for Payer: AlohaCare Medicaid	$6,387.13
Rate for Payer: Hawaii Medical Service Association ABD	$6,387.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,387.13
Rate for Payer: Kaiser Permanente Medicaid	$6,387.13
Rate for Payer: Ohana Health Plan Medicaid	$6,387.13
Rate for Payer: UnitedHealthcare Medicaid	$6,387.13

OTHER BLADDER PROCEDURES

Facility

$15,897.15

Service Code	APR-DRG 4454
Min. Negotiated Rate	$15,897.15
Max. Negotiated Rate	$15,897.15
Rate for Payer: AlohaCare Medicaid	$15,897.15
Rate for Payer: Hawaii Medical Service Association ABD	$15,897.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15,897.15
Rate for Payer: Kaiser Permanente Medicaid	$15,897.15
Rate for Payer: Ohana Health Plan Medicaid	$15,897.15
Rate for Payer: UnitedHealthcare Medicaid	$15,897.15

OTHER BLADDER PROCEDURES

Facility

$8,896.14

Service Code	APR-DRG 4453
Min. Negotiated Rate	$8,896.14
Max. Negotiated Rate	$8,896.14
Rate for Payer: AlohaCare Medicaid	$8,896.14
Rate for Payer: Hawaii Medical Service Association ABD	$8,896.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,896.14
Rate for Payer: Kaiser Permanente Medicaid	$8,896.14
Rate for Payer: Ohana Health Plan Medicaid	$8,896.14
Rate for Payer: UnitedHealthcare Medicaid	$8,896.14

Know your out-of-pocket cost for care.

All Charges