Kona Community Hospital

All Charges

Charge

Type

Setting

Price

OTHER NERVOUS SYSTEM & RELATED PROCEDURES

Facility

$8,633.14

Service Code	APR-DRG 0262
Min. Negotiated Rate	$8,633.14
Max. Negotiated Rate	$8,633.14
Rate for Payer: AlohaCare Medicaid	$8,633.14
Rate for Payer: Hawaii Medical Service Association ABD	$8,633.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,633.14
Rate for Payer: Kaiser Permanente Medicaid	$8,633.14
Rate for Payer: Ohana Health Plan Medicaid	$8,633.14
Rate for Payer: UnitedHealthcare Medicaid	$8,633.14

OTHER NERVOUS SYSTEM & RELATED PROCEDURES

Facility

$7,132.83

Service Code	APR-DRG 0261
Min. Negotiated Rate	$7,132.83
Max. Negotiated Rate	$7,132.83
Rate for Payer: AlohaCare Medicaid	$7,132.83
Rate for Payer: Hawaii Medical Service Association ABD	$7,132.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,132.83
Rate for Payer: Kaiser Permanente Medicaid	$7,132.83
Rate for Payer: Ohana Health Plan Medicaid	$7,132.83
Rate for Payer: UnitedHealthcare Medicaid	$7,132.83

OTHER NERVOUS SYSTEM & RELATED PROCEDURES

Facility

$11,773.85

Service Code	APR-DRG 0263
Min. Negotiated Rate	$11,773.85
Max. Negotiated Rate	$11,773.85
Rate for Payer: AlohaCare Medicaid	$11,773.85
Rate for Payer: Hawaii Medical Service Association ABD	$11,773.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,773.85
Rate for Payer: Kaiser Permanente Medicaid	$11,773.85
Rate for Payer: Ohana Health Plan Medicaid	$11,773.85
Rate for Payer: UnitedHealthcare Medicaid	$11,773.85

OTHER NERVOUS SYSTEM & RELATED PROCEDURES

Facility

$21,254.57

Service Code	APR-DRG 0264
Min. Negotiated Rate	$21,254.57
Max. Negotiated Rate	$21,254.57
Rate for Payer: AlohaCare Medicaid	$21,254.57
Rate for Payer: Hawaii Medical Service Association ABD	$21,254.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21,254.57
Rate for Payer: Kaiser Permanente Medicaid	$21,254.57
Rate for Payer: Ohana Health Plan Medicaid	$21,254.57
Rate for Payer: UnitedHealthcare Medicaid	$21,254.57

OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$2,810.21

Service Code	APR-DRG 4252
Min. Negotiated Rate	$2,810.21
Max. Negotiated Rate	$2,810.21
Rate for Payer: AlohaCare Medicaid	$2,810.21
Rate for Payer: Hawaii Medical Service Association ABD	$2,810.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,810.21
Rate for Payer: Kaiser Permanente Medicaid	$2,810.21
Rate for Payer: Ohana Health Plan Medicaid	$2,810.21
Rate for Payer: UnitedHealthcare Medicaid	$2,810.21

OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$7,099.72

Service Code	APR-DRG 4254
Min. Negotiated Rate	$7,099.72
Max. Negotiated Rate	$7,099.72
Rate for Payer: AlohaCare Medicaid	$7,099.72
Rate for Payer: Hawaii Medical Service Association ABD	$7,099.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,099.72
Rate for Payer: Kaiser Permanente Medicaid	$7,099.72
Rate for Payer: Ohana Health Plan Medicaid	$7,099.72
Rate for Payer: UnitedHealthcare Medicaid	$7,099.72

OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$2,326.88

Service Code	APR-DRG 4251
Min. Negotiated Rate	$2,326.88
Max. Negotiated Rate	$2,326.88
Rate for Payer: AlohaCare Medicaid	$2,326.88
Rate for Payer: Hawaii Medical Service Association ABD	$2,326.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,326.88
Rate for Payer: Kaiser Permanente Medicaid	$2,326.88
Rate for Payer: Ohana Health Plan Medicaid	$2,326.88
Rate for Payer: UnitedHealthcare Medicaid	$2,326.88

OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$3,798.53

Service Code	APR-DRG 4253
Min. Negotiated Rate	$3,798.53
Max. Negotiated Rate	$3,798.53
Rate for Payer: AlohaCare Medicaid	$3,798.53
Rate for Payer: Hawaii Medical Service Association ABD	$3,798.53
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,798.53
Rate for Payer: Kaiser Permanente Medicaid	$3,798.53
Rate for Payer: Ohana Health Plan Medicaid	$3,798.53
Rate for Payer: UnitedHealthcare Medicaid	$3,798.53

OTHER OPEN CRANIOTOMY

Facility

$26,607.54

Service Code	APR-DRG 0274
Min. Negotiated Rate	$26,607.54
Max. Negotiated Rate	$26,607.54
Rate for Payer: AlohaCare Medicaid	$26,607.54
Rate for Payer: Hawaii Medical Service Association ABD	$26,607.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26,607.54
Rate for Payer: Kaiser Permanente Medicaid	$26,607.54
Rate for Payer: Ohana Health Plan Medicaid	$26,607.54
Rate for Payer: UnitedHealthcare Medicaid	$26,607.54

OTHER OPEN CRANIOTOMY

Facility

$8,332.57

Service Code	APR-DRG 0271
Min. Negotiated Rate	$8,332.57
Max. Negotiated Rate	$8,332.57
Rate for Payer: AlohaCare Medicaid	$8,332.57
Rate for Payer: Hawaii Medical Service Association ABD	$8,332.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,332.57
Rate for Payer: Kaiser Permanente Medicaid	$8,332.57
Rate for Payer: Ohana Health Plan Medicaid	$8,332.57
Rate for Payer: UnitedHealthcare Medicaid	$8,332.57

OTHER OPEN CRANIOTOMY

Facility

$9,402.40

Service Code	APR-DRG 0272
Min. Negotiated Rate	$9,402.40
Max. Negotiated Rate	$9,402.40
Rate for Payer: AlohaCare Medicaid	$9,402.40
Rate for Payer: Hawaii Medical Service Association ABD	$9,402.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,402.40
Rate for Payer: Kaiser Permanente Medicaid	$9,402.40
Rate for Payer: Ohana Health Plan Medicaid	$9,402.40
Rate for Payer: UnitedHealthcare Medicaid	$9,402.40

OTHER OPEN CRANIOTOMY

Facility

$13,282.44

Service Code	APR-DRG 0273
Min. Negotiated Rate	$13,282.44
Max. Negotiated Rate	$13,282.44
Rate for Payer: AlohaCare Medicaid	$13,282.44
Rate for Payer: Hawaii Medical Service Association ABD	$13,282.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,282.44
Rate for Payer: Kaiser Permanente Medicaid	$13,282.44
Rate for Payer: Ohana Health Plan Medicaid	$13,282.44
Rate for Payer: UnitedHealthcare Medicaid	$13,282.44

OTHER O.R. PROCEDURES FOR INJURIES WITH CC

Facility

$45,128.30

Service Code	MSDRG 908
Min. Negotiated Rate	$26,242.40
Max. Negotiated Rate	$45,128.30
Rate for Payer: AlohaCare Medicare	$26,242.40
Rate for Payer: Devoted Health Medicare	$28,866.64
Rate for Payer: Hawaii Medical Service Association Commercial	$45,128.30
Rate for Payer: Hawaii Medical Service Association Medicare	$26,242.40
Rate for Payer: Humana Medicare	$26,242.40
Rate for Payer: Kaiser Permanente Commercial	$34,417.20
Rate for Payer: Kaiser Permanente Medicare	$26,242.40
Rate for Payer: Ohana Health Plan Medicare	$26,242.40
Rate for Payer: UnitedHealthcare Medicare	$26,242.40

OTHER O.R. PROCEDURES FOR INJURIES WITH MCC

Facility

$66,227.93

Service Code	MSDRG 907
Min. Negotiated Rate	$48,286.32
Max. Negotiated Rate	$66,227.93
Rate for Payer: AlohaCare Medicare	$50,497.42
Rate for Payer: Devoted Health Medicare	$55,547.16
Rate for Payer: Hawaii Medical Service Association Commercial	$48,286.32
Rate for Payer: Hawaii Medical Service Association Medicare	$50,497.42
Rate for Payer: Humana Medicare	$50,497.42
Rate for Payer: Kaiser Permanente Commercial	$66,227.93
Rate for Payer: Kaiser Permanente Medicare	$50,497.42
Rate for Payer: Ohana Health Plan Medicare	$50,497.42
Rate for Payer: UnitedHealthcare Medicare	$50,497.42

OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC

Facility

$23,383.79

Service Code	MSDRG 909
Min. Negotiated Rate	$17,265.64
Max. Negotiated Rate	$23,383.79
Rate for Payer: AlohaCare Medicare	$17,265.64
Rate for Payer: Devoted Health Medicare	$18,992.20
Rate for Payer: Hawaii Medical Service Association Commercial	$23,383.79
Rate for Payer: Hawaii Medical Service Association Medicare	$17,265.64
Rate for Payer: Humana Medicare	$17,265.64
Rate for Payer: Kaiser Permanente Commercial	$22,644.08
Rate for Payer: Kaiser Permanente Medicare	$17,265.64
Rate for Payer: Ohana Health Plan Medicare	$17,265.64
Rate for Payer: UnitedHealthcare Medicare	$17,265.64

OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS

Facility

$27,725.77

Service Code	APR-DRG 6814
Min. Negotiated Rate	$27,725.77
Max. Negotiated Rate	$27,725.77
Rate for Payer: AlohaCare Medicaid	$27,725.77
Rate for Payer: Hawaii Medical Service Association ABD	$27,725.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27,725.77
Rate for Payer: Kaiser Permanente Medicaid	$27,725.77
Rate for Payer: Ohana Health Plan Medicaid	$27,725.77
Rate for Payer: UnitedHealthcare Medicaid	$27,725.77

OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS

Facility

$13,782.96

Service Code	APR-DRG 6813
Min. Negotiated Rate	$13,782.96
Max. Negotiated Rate	$13,782.96
Rate for Payer: AlohaCare Medicaid	$13,782.96
Rate for Payer: Hawaii Medical Service Association ABD	$13,782.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,782.96
Rate for Payer: Kaiser Permanente Medicaid	$13,782.96
Rate for Payer: Ohana Health Plan Medicaid	$13,782.96
Rate for Payer: UnitedHealthcare Medicaid	$13,782.96

OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS

Facility

$7,945.39

Service Code	APR-DRG 6812
Min. Negotiated Rate	$7,945.39
Max. Negotiated Rate	$7,945.39
Rate for Payer: AlohaCare Medicaid	$7,945.39
Rate for Payer: Hawaii Medical Service Association ABD	$7,945.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,945.39
Rate for Payer: Kaiser Permanente Medicaid	$7,945.39
Rate for Payer: Ohana Health Plan Medicaid	$7,945.39
Rate for Payer: UnitedHealthcare Medicaid	$7,945.39

OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS

Facility

$5,996.14

Service Code	APR-DRG 6811
Min. Negotiated Rate	$5,996.14
Max. Negotiated Rate	$5,996.14
Rate for Payer: AlohaCare Medicaid	$5,996.14
Rate for Payer: Hawaii Medical Service Association ABD	$5,996.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,996.14
Rate for Payer: Kaiser Permanente Medicaid	$5,996.14
Rate for Payer: Ohana Health Plan Medicaid	$5,996.14
Rate for Payer: UnitedHealthcare Medicaid	$5,996.14

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$155,369.61

Service Code	MSDRG 958
Min. Negotiated Rate	$55,424.43
Max. Negotiated Rate	$155,369.61
Rate for Payer: AlohaCare Medicare	$55,424.43
Rate for Payer: Devoted Health Medicare	$60,966.87
Rate for Payer: Hawaii Medical Service Association Commercial	$155,369.61
Rate for Payer: Hawaii Medical Service Association Medicare	$55,424.43
Rate for Payer: Humana Medicare	$55,424.43
Rate for Payer: Kaiser Permanente Commercial	$72,689.77
Rate for Payer: Kaiser Permanente Medicare	$55,424.43
Rate for Payer: Ohana Health Plan Medicare	$55,424.43
Rate for Payer: UnitedHealthcare Medicare	$55,424.43

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$155,369.61

Service Code	MSDRG 957
Min. Negotiated Rate	$100,222.77
Max. Negotiated Rate	$155,369.61
Rate for Payer: AlohaCare Medicare	$100,222.77
Rate for Payer: Devoted Health Medicare	$110,245.05
Rate for Payer: Hawaii Medical Service Association Commercial	$155,369.61
Rate for Payer: Hawaii Medical Service Association Medicare	$100,222.77
Rate for Payer: Humana Medicare	$100,222.77
Rate for Payer: Kaiser Permanente Commercial	$131,443.27
Rate for Payer: Kaiser Permanente Medicare	$100,222.77
Rate for Payer: Ohana Health Plan Medicare	$100,222.77
Rate for Payer: UnitedHealthcare Medicare	$100,222.77

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$155,369.61

Service Code	MSDRG 959
Min. Negotiated Rate	$38,723.06
Max. Negotiated Rate	$155,369.61
Rate for Payer: AlohaCare Medicare	$38,723.06
Rate for Payer: Devoted Health Medicare	$42,595.37
Rate for Payer: Hawaii Medical Service Association Commercial	$155,369.61
Rate for Payer: Hawaii Medical Service Association Medicare	$38,723.06
Rate for Payer: Humana Medicare	$38,723.06
Rate for Payer: Kaiser Permanente Commercial	$50,785.72
Rate for Payer: Kaiser Permanente Medicare	$38,723.06
Rate for Payer: Ohana Health Plan Medicare	$38,723.06
Rate for Payer: UnitedHealthcare Medicare	$38,723.06

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC

Facility

$42,982.78

Service Code	MSDRG 803
Min. Negotiated Rate	$24,449.68
Max. Negotiated Rate	$42,982.78
Rate for Payer: AlohaCare Medicare	$24,449.68
Rate for Payer: Devoted Health Medicare	$26,894.65
Rate for Payer: Hawaii Medical Service Association Commercial	$42,982.78
Rate for Payer: Hawaii Medical Service Association Medicare	$24,449.68
Rate for Payer: Humana Medicare	$24,449.68
Rate for Payer: Kaiser Permanente Commercial	$32,066.03
Rate for Payer: Kaiser Permanente Medicare	$24,449.68
Rate for Payer: Ohana Health Plan Medicare	$24,449.68
Rate for Payer: UnitedHealthcare Medicare	$24,449.68

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC

Facility

$68,725.73

Service Code	MSDRG 802
Min. Negotiated Rate	$42,982.78
Max. Negotiated Rate	$68,725.73
Rate for Payer: AlohaCare Medicare	$52,401.95
Rate for Payer: Devoted Health Medicare	$57,642.14
Rate for Payer: Hawaii Medical Service Association Commercial	$42,982.78
Rate for Payer: Hawaii Medical Service Association Medicare	$52,401.95
Rate for Payer: Humana Medicare	$52,401.95
Rate for Payer: Kaiser Permanente Commercial	$68,725.73
Rate for Payer: Kaiser Permanente Medicare	$52,401.95
Rate for Payer: Ohana Health Plan Medicare	$52,401.95
Rate for Payer: UnitedHealthcare Medicare	$52,401.95

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC

Facility

$42,982.78

Service Code	MSDRG 804
Min. Negotiated Rate	$17,835.14
Max. Negotiated Rate	$42,982.78
Rate for Payer: AlohaCare Medicare	$17,835.14
Rate for Payer: Devoted Health Medicare	$19,618.65
Rate for Payer: Hawaii Medical Service Association Commercial	$42,982.78
Rate for Payer: Hawaii Medical Service Association Medicare	$17,835.14
Rate for Payer: Humana Medicare	$17,835.14
Rate for Payer: Kaiser Permanente Commercial	$23,391.00
Rate for Payer: Kaiser Permanente Medicare	$17,835.14
Rate for Payer: Ohana Health Plan Medicare	$17,835.14
Rate for Payer: UnitedHealthcare Medicare	$17,835.14

Know your out-of-pocket cost for care.

All Charges