Kona Community Hospital

All Charges

Charge

Type

Setting

Price

OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT

Facility

$22,823.47

Service Code	MSDRG 124
Min. Negotiated Rate	$16,175.80
Max. Negotiated Rate	$22,823.47
Rate for Payer: AlohaCare Medicare	$17,402.42
Rate for Payer: Devoted Health Medicare	$19,142.66
Rate for Payer: Hawaii Medical Service Association Commercial	$16,175.80
Rate for Payer: Hawaii Medical Service Association Medicare	$17,402.42
Rate for Payer: Humana Medicare	$17,402.42
Rate for Payer: Kaiser Permanente Commercial	$22,823.47
Rate for Payer: Kaiser Permanente Medicare	$17,402.42
Rate for Payer: Ohana Health Plan Medicare	$17,402.42
Rate for Payer: UnitedHealthcare Medicare	$17,402.42

OTHER DISORDERS OF THE EYE WITHOUT MCC

Facility

$13,244.55

Service Code	MSDRG 125
Min. Negotiated Rate	$8,172.27
Max. Negotiated Rate	$13,244.55
Rate for Payer: AlohaCare Medicare	$10,098.69
Rate for Payer: Devoted Health Medicare	$11,108.56
Rate for Payer: Hawaii Medical Service Association Commercial	$8,172.27
Rate for Payer: Hawaii Medical Service Association Medicare	$10,098.69
Rate for Payer: Humana Medicare	$10,098.69
Rate for Payer: Kaiser Permanente Commercial	$13,244.55
Rate for Payer: Kaiser Permanente Medicare	$10,098.69
Rate for Payer: Ohana Health Plan Medicare	$10,098.69
Rate for Payer: UnitedHealthcare Medicare	$10,098.69

OTHER DISORDERS OF THE LIVER

Facility

$2,716.60

Service Code	APR-DRG 2831
Min. Negotiated Rate	$2,716.60
Max. Negotiated Rate	$2,716.60
Rate for Payer: AlohaCare Medicaid	$2,716.60
Rate for Payer: Hawaii Medical Service Association ABD	$2,716.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,716.60
Rate for Payer: Kaiser Permanente Medicaid	$2,716.60
Rate for Payer: Ohana Health Plan Medicaid	$2,716.60
Rate for Payer: UnitedHealthcare Medicaid	$2,716.60

OTHER DISORDERS OF THE LIVER

Facility

$8,912.06

Service Code	APR-DRG 2834
Min. Negotiated Rate	$8,912.06
Max. Negotiated Rate	$8,912.06
Rate for Payer: AlohaCare Medicaid	$8,912.06
Rate for Payer: Hawaii Medical Service Association ABD	$8,912.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,912.06
Rate for Payer: Kaiser Permanente Medicaid	$8,912.06
Rate for Payer: Ohana Health Plan Medicaid	$8,912.06
Rate for Payer: UnitedHealthcare Medicaid	$8,912.06

OTHER DISORDERS OF THE LIVER

Facility

$4,785.57

Service Code	APR-DRG 2833
Min. Negotiated Rate	$4,785.57
Max. Negotiated Rate	$4,785.57
Rate for Payer: AlohaCare Medicaid	$4,785.57
Rate for Payer: Hawaii Medical Service Association ABD	$4,785.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,785.57
Rate for Payer: Kaiser Permanente Medicaid	$4,785.57
Rate for Payer: Ohana Health Plan Medicaid	$4,785.57
Rate for Payer: UnitedHealthcare Medicaid	$4,785.57

OTHER DISORDERS OF THE LIVER

Facility

$3,391.61

Service Code	APR-DRG 2832
Min. Negotiated Rate	$3,391.61
Max. Negotiated Rate	$3,391.61
Rate for Payer: AlohaCare Medicaid	$3,391.61
Rate for Payer: Hawaii Medical Service Association ABD	$3,391.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,391.61
Rate for Payer: Kaiser Permanente Medicaid	$3,391.61
Rate for Payer: Ohana Health Plan Medicaid	$3,391.61
Rate for Payer: UnitedHealthcare Medicaid	$3,391.61

OTHER DRUG ABUSE & DEPENDENCE

Facility

$2,607.07

Service Code	APR-DRG 7761
Min. Negotiated Rate	$2,607.07
Max. Negotiated Rate	$2,607.07
Rate for Payer: AlohaCare Medicaid	$2,607.07
Rate for Payer: Hawaii Medical Service Association ABD	$2,607.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,607.07
Rate for Payer: Kaiser Permanente Medicaid	$2,607.07
Rate for Payer: Ohana Health Plan Medicaid	$2,607.07
Rate for Payer: UnitedHealthcare Medicaid	$2,607.07

OTHER DRUG ABUSE & DEPENDENCE

Facility

$4,891.92

Service Code	APR-DRG 7763
Min. Negotiated Rate	$4,891.92
Max. Negotiated Rate	$4,891.92
Rate for Payer: AlohaCare Medicaid	$4,891.92
Rate for Payer: Hawaii Medical Service Association ABD	$4,891.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,891.92
Rate for Payer: Kaiser Permanente Medicaid	$4,891.92
Rate for Payer: Ohana Health Plan Medicaid	$4,891.92
Rate for Payer: UnitedHealthcare Medicaid	$4,891.92

OTHER DRUG ABUSE & DEPENDENCE

Facility

$3,170.23

Service Code	APR-DRG 7762
Min. Negotiated Rate	$3,170.23
Max. Negotiated Rate	$3,170.23
Rate for Payer: AlohaCare Medicaid	$3,170.23
Rate for Payer: Hawaii Medical Service Association ABD	$3,170.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,170.23
Rate for Payer: Kaiser Permanente Medicaid	$3,170.23
Rate for Payer: Ohana Health Plan Medicaid	$3,170.23
Rate for Payer: UnitedHealthcare Medicaid	$3,170.23

OTHER DRUG ABUSE & DEPENDENCE

Facility

$8,722.70

Service Code	APR-DRG 7764
Min. Negotiated Rate	$8,722.70
Max. Negotiated Rate	$8,722.70
Rate for Payer: AlohaCare Medicaid	$8,722.70
Rate for Payer: Hawaii Medical Service Association ABD	$8,722.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,722.70
Rate for Payer: Kaiser Permanente Medicaid	$8,722.70
Rate for Payer: Ohana Health Plan Medicaid	$8,722.70
Rate for Payer: UnitedHealthcare Medicaid	$8,722.70

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC

Facility

$15,809.62

Service Code	MSDRG 155
Min. Negotiated Rate	$12,054.51
Max. Negotiated Rate	$15,809.62
Rate for Payer: AlohaCare Medicare	$12,054.51
Rate for Payer: Devoted Health Medicare	$13,259.96
Rate for Payer: Hawaii Medical Service Association Commercial	$15,066.88
Rate for Payer: Hawaii Medical Service Association Medicare	$12,054.51
Rate for Payer: Humana Medicare	$12,054.51
Rate for Payer: Kaiser Permanente Commercial	$15,809.62
Rate for Payer: Kaiser Permanente Medicare	$12,054.51
Rate for Payer: Ohana Health Plan Medicare	$12,054.51
Rate for Payer: UnitedHealthcare Medicare	$12,054.51

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC

Facility

$26,970.38

Service Code	MSDRG 154
Min. Negotiated Rate	$15,066.88
Max. Negotiated Rate	$26,970.38
Rate for Payer: AlohaCare Medicare	$20,564.35
Rate for Payer: Devoted Health Medicare	$22,620.78
Rate for Payer: Hawaii Medical Service Association Commercial	$15,066.88
Rate for Payer: Hawaii Medical Service Association Medicare	$20,564.35
Rate for Payer: Humana Medicare	$20,564.35
Rate for Payer: Kaiser Permanente Commercial	$26,970.38
Rate for Payer: Kaiser Permanente Medicare	$20,564.35
Rate for Payer: Ohana Health Plan Medicare	$20,564.35
Rate for Payer: UnitedHealthcare Medicare	$20,564.35

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC

Facility

$15,066.88

Service Code	MSDRG 156
Min. Negotiated Rate	$9,089.86
Max. Negotiated Rate	$15,066.88
Rate for Payer: AlohaCare Medicare	$9,089.86
Rate for Payer: Devoted Health Medicare	$9,998.85
Rate for Payer: Hawaii Medical Service Association Commercial	$15,066.88
Rate for Payer: Hawaii Medical Service Association Medicare	$9,089.86
Rate for Payer: Humana Medicare	$9,089.86
Rate for Payer: Kaiser Permanente Commercial	$11,921.48
Rate for Payer: Kaiser Permanente Medicare	$9,089.86
Rate for Payer: Ohana Health Plan Medicare	$9,089.86
Rate for Payer: UnitedHealthcare Medicare	$9,089.86

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC

Facility

$35,123.90

Service Code	MSDRG 144
Min. Negotiated Rate	$22,792.43
Max. Negotiated Rate	$35,123.90
Rate for Payer: AlohaCare Medicare	$22,792.43
Rate for Payer: Devoted Health Medicare	$25,071.67
Rate for Payer: Hawaii Medical Service Association Commercial	$35,123.90
Rate for Payer: Hawaii Medical Service Association Medicare	$22,792.43
Rate for Payer: Humana Medicare	$22,792.43
Rate for Payer: Kaiser Permanente Commercial	$29,892.53
Rate for Payer: Kaiser Permanente Medicare	$22,792.43
Rate for Payer: Ohana Health Plan Medicare	$22,792.43
Rate for Payer: UnitedHealthcare Medicare	$22,792.43

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC

Facility

$102,502.96

Service Code	MSDRG 143
Min. Negotiated Rate	$49,278.15
Max. Negotiated Rate	$102,502.96
Rate for Payer: AlohaCare Medicare	$49,278.15
Rate for Payer: Devoted Health Medicare	$54,205.96
Rate for Payer: Hawaii Medical Service Association Commercial	$102,502.96
Rate for Payer: Hawaii Medical Service Association Medicare	$49,278.15
Rate for Payer: Humana Medicare	$49,278.15
Rate for Payer: Kaiser Permanente Commercial	$64,628.85
Rate for Payer: Kaiser Permanente Medicare	$49,278.15
Rate for Payer: Ohana Health Plan Medicare	$49,278.15
Rate for Payer: UnitedHealthcare Medicare	$49,278.15

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$22,636.47

Service Code	MSDRG 145
Min. Negotiated Rate	$15,813.58
Max. Negotiated Rate	$22,636.47
Rate for Payer: AlohaCare Medicare	$15,813.58
Rate for Payer: Devoted Health Medicare	$17,394.94
Rate for Payer: Hawaii Medical Service Association Commercial	$22,636.47
Rate for Payer: Hawaii Medical Service Association Medicare	$15,813.58
Rate for Payer: Humana Medicare	$15,813.58
Rate for Payer: Kaiser Permanente Commercial	$20,739.67
Rate for Payer: Kaiser Permanente Medicare	$15,813.58
Rate for Payer: Ohana Health Plan Medicare	$15,813.58
Rate for Payer: UnitedHealthcare Medicare	$15,813.58

OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES

Facility

$9,275.04

Service Code	APR-DRG 1154
Min. Negotiated Rate	$9,275.04
Max. Negotiated Rate	$9,275.04
Rate for Payer: AlohaCare Medicaid	$9,275.04
Rate for Payer: Hawaii Medical Service Association ABD	$9,275.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,275.04
Rate for Payer: Kaiser Permanente Medicaid	$9,275.04
Rate for Payer: Ohana Health Plan Medicaid	$9,275.04
Rate for Payer: UnitedHealthcare Medicaid	$9,275.04

OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES

Facility

$2,383.55

Service Code	APR-DRG 1151
Min. Negotiated Rate	$2,383.55
Max. Negotiated Rate	$2,383.55
Rate for Payer: AlohaCare Medicaid	$2,383.55
Rate for Payer: Hawaii Medical Service Association ABD	$2,383.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,383.55
Rate for Payer: Kaiser Permanente Medicaid	$2,383.55
Rate for Payer: Ohana Health Plan Medicaid	$2,383.55
Rate for Payer: UnitedHealthcare Medicaid	$2,383.55

OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES

Facility

$4,925.67

Service Code	APR-DRG 1153
Min. Negotiated Rate	$4,925.67
Max. Negotiated Rate	$4,925.67
Rate for Payer: AlohaCare Medicaid	$4,925.67
Rate for Payer: Hawaii Medical Service Association ABD	$4,925.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,925.67
Rate for Payer: Kaiser Permanente Medicaid	$4,925.67
Rate for Payer: Ohana Health Plan Medicaid	$4,925.67
Rate for Payer: UnitedHealthcare Medicaid	$4,925.67

OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES

Facility

$3,231.78

Service Code	APR-DRG 1152
Min. Negotiated Rate	$3,231.78
Max. Negotiated Rate	$3,231.78
Rate for Payer: AlohaCare Medicaid	$3,231.78
Rate for Payer: Hawaii Medical Service Association ABD	$3,231.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,231.78
Rate for Payer: Kaiser Permanente Medicaid	$3,231.78
Rate for Payer: Ohana Health Plan Medicaid	$3,231.78
Rate for Payer: UnitedHealthcare Medicaid	$3,231.78

OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES

Facility

$18,308.09

Service Code	APR-DRG 0984
Min. Negotiated Rate	$18,308.09
Max. Negotiated Rate	$18,308.09
Rate for Payer: AlohaCare Medicaid	$18,308.09
Rate for Payer: Hawaii Medical Service Association ABD	$18,308.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18,308.09
Rate for Payer: Kaiser Permanente Medicaid	$18,308.09
Rate for Payer: Ohana Health Plan Medicaid	$18,308.09
Rate for Payer: UnitedHealthcare Medicaid	$18,308.09

OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES

Facility

$4,739.09

Service Code	APR-DRG 0981
Min. Negotiated Rate	$4,739.09
Max. Negotiated Rate	$4,739.09
Rate for Payer: AlohaCare Medicaid	$4,739.09
Rate for Payer: Hawaii Medical Service Association ABD	$4,739.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,739.09
Rate for Payer: Kaiser Permanente Medicaid	$4,739.09
Rate for Payer: Ohana Health Plan Medicaid	$4,739.09
Rate for Payer: UnitedHealthcare Medicaid	$4,739.09

OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES

Facility

$6,068.10

Service Code	APR-DRG 0982
Min. Negotiated Rate	$6,068.10
Max. Negotiated Rate	$6,068.10
Rate for Payer: AlohaCare Medicaid	$6,068.10
Rate for Payer: Hawaii Medical Service Association ABD	$6,068.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,068.10
Rate for Payer: Kaiser Permanente Medicaid	$6,068.10
Rate for Payer: Ohana Health Plan Medicaid	$6,068.10
Rate for Payer: UnitedHealthcare Medicaid	$6,068.10

OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES

Facility

$10,212.41

Service Code	APR-DRG 0983
Min. Negotiated Rate	$10,212.41
Max. Negotiated Rate	$10,212.41
Rate for Payer: AlohaCare Medicaid	$10,212.41
Rate for Payer: Hawaii Medical Service Association ABD	$10,212.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,212.41
Rate for Payer: Kaiser Permanente Medicaid	$10,212.41
Rate for Payer: Ohana Health Plan Medicaid	$10,212.41
Rate for Payer: UnitedHealthcare Medicaid	$10,212.41

OTHER ENDOCRINE DISORDERS

Facility

$5,260.63

Service Code	APR-DRG 4243
Min. Negotiated Rate	$5,260.63
Max. Negotiated Rate	$5,260.63
Rate for Payer: AlohaCare Medicaid	$5,260.63
Rate for Payer: Hawaii Medical Service Association ABD	$5,260.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,260.63
Rate for Payer: Kaiser Permanente Medicaid	$5,260.63
Rate for Payer: Ohana Health Plan Medicaid	$5,260.63
Rate for Payer: UnitedHealthcare Medicaid	$5,260.63

Know your out-of-pocket cost for care.

All Charges