Kona Community Hospital

All Charges

Charge

Type

Setting

Price

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$12,513.18

Service Code	APR-DRG 0293
Min. Negotiated Rate	$12,513.18
Max. Negotiated Rate	$12,513.18
Rate for Payer: AlohaCare Medicaid	$12,513.18
Rate for Payer: Hawaii Medical Service Association ABD	$12,513.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,513.18
Rate for Payer: Kaiser Permanente Medicaid	$12,513.18
Rate for Payer: Ohana Health Plan Medicaid	$12,513.18
Rate for Payer: UnitedHealthcare Medicaid	$12,513.18

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$9,003.76

Service Code	APR-DRG 0292
Min. Negotiated Rate	$9,003.76
Max. Negotiated Rate	$9,003.76
Rate for Payer: AlohaCare Medicaid	$9,003.76
Rate for Payer: Hawaii Medical Service Association ABD	$9,003.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,003.76
Rate for Payer: Kaiser Permanente Medicaid	$9,003.76
Rate for Payer: Ohana Health Plan Medicaid	$9,003.76
Rate for Payer: UnitedHealthcare Medicaid	$9,003.76

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$21,346.91

Service Code	APR-DRG 0294
Min. Negotiated Rate	$21,346.91
Max. Negotiated Rate	$21,346.91
Rate for Payer: AlohaCare Medicaid	$21,346.91
Rate for Payer: Hawaii Medical Service Association ABD	$21,346.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21,346.91
Rate for Payer: Kaiser Permanente Medicaid	$21,346.91
Rate for Payer: Ohana Health Plan Medicaid	$21,346.91
Rate for Payer: UnitedHealthcare Medicaid	$21,346.91

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$8,103.32

Service Code	APR-DRG 0291
Min. Negotiated Rate	$8,103.32
Max. Negotiated Rate	$8,103.32
Rate for Payer: AlohaCare Medicaid	$8,103.32
Rate for Payer: Hawaii Medical Service Association ABD	$8,103.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,103.32
Rate for Payer: Kaiser Permanente Medicaid	$8,103.32
Rate for Payer: Ohana Health Plan Medicaid	$8,103.32
Rate for Payer: UnitedHealthcare Medicaid	$8,103.32

OTHER PERIPHERAL VASCULAR PROCEDURES

Facility

$11,465.00

Service Code	APR-DRG 1822
Min. Negotiated Rate	$11,465.00
Max. Negotiated Rate	$11,465.00
Rate for Payer: AlohaCare Medicaid	$11,465.00
Rate for Payer: Hawaii Medical Service Association ABD	$11,465.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,465.00
Rate for Payer: Kaiser Permanente Medicaid	$11,465.00
Rate for Payer: Ohana Health Plan Medicaid	$11,465.00
Rate for Payer: UnitedHealthcare Medicaid	$11,465.00

OTHER PERIPHERAL VASCULAR PROCEDURES

Facility

$22,863.77

Service Code	APR-DRG 1824
Min. Negotiated Rate	$22,863.77
Max. Negotiated Rate	$22,863.77
Rate for Payer: AlohaCare Medicaid	$22,863.77
Rate for Payer: Hawaii Medical Service Association ABD	$22,863.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22,863.77
Rate for Payer: Kaiser Permanente Medicaid	$22,863.77
Rate for Payer: Ohana Health Plan Medicaid	$22,863.77
Rate for Payer: UnitedHealthcare Medicaid	$22,863.77

OTHER PERIPHERAL VASCULAR PROCEDURES

Facility

$12,546.93

Service Code	APR-DRG 1823
Min. Negotiated Rate	$12,546.93
Max. Negotiated Rate	$12,546.93
Rate for Payer: AlohaCare Medicaid	$12,546.93
Rate for Payer: Hawaii Medical Service Association ABD	$12,546.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,546.93
Rate for Payer: Kaiser Permanente Medicaid	$12,546.93
Rate for Payer: Ohana Health Plan Medicaid	$12,546.93
Rate for Payer: UnitedHealthcare Medicaid	$12,546.93

OTHER PERIPHERAL VASCULAR PROCEDURES

Facility

$9,732.26

Service Code	APR-DRG 1821
Min. Negotiated Rate	$9,732.26
Max. Negotiated Rate	$9,732.26
Rate for Payer: AlohaCare Medicaid	$9,732.26
Rate for Payer: Hawaii Medical Service Association ABD	$9,732.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,732.26
Rate for Payer: Kaiser Permanente Medicaid	$9,732.26
Rate for Payer: Ohana Health Plan Medicaid	$9,732.26
Rate for Payer: UnitedHealthcare Medicaid	$9,732.26

OTHER PNEUMONIA

Facility

$4,668.40

Service Code	APR-DRG 1393
Min. Negotiated Rate	$4,668.40
Max. Negotiated Rate	$4,668.40
Rate for Payer: AlohaCare Medicaid	$4,668.40
Rate for Payer: Hawaii Medical Service Association ABD	$4,668.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,668.40
Rate for Payer: Kaiser Permanente Medicaid	$4,668.40
Rate for Payer: Ohana Health Plan Medicaid	$4,668.40
Rate for Payer: UnitedHealthcare Medicaid	$4,668.40

OTHER PNEUMONIA

Facility

$2,422.40

Service Code	APR-DRG 1391
Min. Negotiated Rate	$2,422.40
Max. Negotiated Rate	$2,422.40
Rate for Payer: AlohaCare Medicaid	$2,422.40
Rate for Payer: Hawaii Medical Service Association ABD	$2,422.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,422.40
Rate for Payer: Kaiser Permanente Medicaid	$2,422.40
Rate for Payer: Ohana Health Plan Medicaid	$2,422.40
Rate for Payer: UnitedHealthcare Medicaid	$2,422.40

OTHER PNEUMONIA

Facility

$3,304.37

Service Code	APR-DRG 1392
Min. Negotiated Rate	$3,304.37
Max. Negotiated Rate	$3,304.37
Rate for Payer: AlohaCare Medicaid	$3,304.37
Rate for Payer: Hawaii Medical Service Association ABD	$3,304.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,304.37
Rate for Payer: Kaiser Permanente Medicaid	$3,304.37
Rate for Payer: Ohana Health Plan Medicaid	$3,304.37
Rate for Payer: UnitedHealthcare Medicaid	$3,304.37

OTHER PNEUMONIA

Facility

$6,994.01

Service Code	APR-DRG 1394
Min. Negotiated Rate	$6,994.01
Max. Negotiated Rate	$6,994.01
Rate for Payer: AlohaCare Medicaid	$6,994.01
Rate for Payer: Hawaii Medical Service Association ABD	$6,994.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,994.01
Rate for Payer: Kaiser Permanente Medicaid	$6,994.01
Rate for Payer: Ohana Health Plan Medicaid	$6,994.01
Rate for Payer: UnitedHealthcare Medicaid	$6,994.01

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS

Facility

$23,242.04

Service Code	APR-DRG 4054
Min. Negotiated Rate	$23,242.04
Max. Negotiated Rate	$23,242.04
Rate for Payer: AlohaCare Medicaid	$23,242.04
Rate for Payer: Hawaii Medical Service Association ABD	$23,242.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23,242.04
Rate for Payer: Kaiser Permanente Medicaid	$23,242.04
Rate for Payer: Ohana Health Plan Medicaid	$23,242.04
Rate for Payer: UnitedHealthcare Medicaid	$23,242.04

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS

Facility

$8,249.78

Service Code	APR-DRG 4052
Min. Negotiated Rate	$8,249.78
Max. Negotiated Rate	$8,249.78
Rate for Payer: AlohaCare Medicaid	$8,249.78
Rate for Payer: Hawaii Medical Service Association ABD	$8,249.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,249.78
Rate for Payer: Kaiser Permanente Medicaid	$8,249.78
Rate for Payer: Ohana Health Plan Medicaid	$8,249.78
Rate for Payer: UnitedHealthcare Medicaid	$8,249.78

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS

Facility

$11,570.07

Service Code	APR-DRG 4053
Min. Negotiated Rate	$11,570.07
Max. Negotiated Rate	$11,570.07
Rate for Payer: AlohaCare Medicaid	$11,570.07
Rate for Payer: Hawaii Medical Service Association ABD	$11,570.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,570.07
Rate for Payer: Kaiser Permanente Medicaid	$11,570.07
Rate for Payer: Ohana Health Plan Medicaid	$11,570.07
Rate for Payer: UnitedHealthcare Medicaid	$11,570.07

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS

Facility

$6,797.87

Service Code	APR-DRG 4051
Min. Negotiated Rate	$6,797.87
Max. Negotiated Rate	$6,797.87
Rate for Payer: AlohaCare Medicaid	$6,797.87
Rate for Payer: Hawaii Medical Service Association ABD	$6,797.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,797.87
Rate for Payer: Kaiser Permanente Medicaid	$6,797.87
Rate for Payer: Ohana Health Plan Medicaid	$6,797.87
Rate for Payer: UnitedHealthcare Medicaid	$6,797.87

OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS

Facility

$5,446.58

Service Code	APR-DRG 6511
Min. Negotiated Rate	$5,446.58
Max. Negotiated Rate	$5,446.58
Rate for Payer: AlohaCare Medicaid	$5,446.58
Rate for Payer: Hawaii Medical Service Association ABD	$5,446.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,446.58
Rate for Payer: Kaiser Permanente Medicaid	$5,446.58
Rate for Payer: Ohana Health Plan Medicaid	$5,446.58
Rate for Payer: UnitedHealthcare Medicaid	$5,446.58

OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS

Facility

$11,581.54

Service Code	APR-DRG 6513
Min. Negotiated Rate	$11,581.54
Max. Negotiated Rate	$11,581.54
Rate for Payer: AlohaCare Medicaid	$11,581.54
Rate for Payer: Hawaii Medical Service Association ABD	$11,581.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,581.54
Rate for Payer: Kaiser Permanente Medicaid	$11,581.54
Rate for Payer: Ohana Health Plan Medicaid	$11,581.54
Rate for Payer: UnitedHealthcare Medicaid	$11,581.54

OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS

Facility

$7,564.58

Service Code	APR-DRG 6512
Min. Negotiated Rate	$7,564.58
Max. Negotiated Rate	$7,564.58
Rate for Payer: AlohaCare Medicaid	$7,564.58
Rate for Payer: Hawaii Medical Service Association ABD	$7,564.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,564.58
Rate for Payer: Kaiser Permanente Medicaid	$7,564.58
Rate for Payer: Ohana Health Plan Medicaid	$7,564.58
Rate for Payer: UnitedHealthcare Medicaid	$7,564.58

OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS

Facility

$26,959.06

Service Code	APR-DRG 6514
Min. Negotiated Rate	$26,959.06
Max. Negotiated Rate	$26,959.06
Rate for Payer: AlohaCare Medicaid	$26,959.06
Rate for Payer: Hawaii Medical Service Association ABD	$26,959.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26,959.06
Rate for Payer: Kaiser Permanente Medicaid	$26,959.06
Rate for Payer: Ohana Health Plan Medicaid	$26,959.06
Rate for Payer: UnitedHealthcare Medicaid	$26,959.06

OTHER RESPIRATORY & CHEST PROCEDURES

Facility

$7,015.66

Service Code	APR-DRG 1211
Min. Negotiated Rate	$7,015.66
Max. Negotiated Rate	$7,015.66
Rate for Payer: AlohaCare Medicaid	$7,015.66
Rate for Payer: Hawaii Medical Service Association ABD	$7,015.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,015.66
Rate for Payer: Kaiser Permanente Medicaid	$7,015.66
Rate for Payer: Ohana Health Plan Medicaid	$7,015.66
Rate for Payer: UnitedHealthcare Medicaid	$7,015.66

OTHER RESPIRATORY & CHEST PROCEDURES

Facility

$8,730.57

Service Code	APR-DRG 1212
Min. Negotiated Rate	$8,730.57
Max. Negotiated Rate	$8,730.57
Rate for Payer: AlohaCare Medicaid	$8,730.57
Rate for Payer: Hawaii Medical Service Association ABD	$8,730.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,730.57
Rate for Payer: Kaiser Permanente Medicaid	$8,730.57
Rate for Payer: Ohana Health Plan Medicaid	$8,730.57
Rate for Payer: UnitedHealthcare Medicaid	$8,730.57

OTHER RESPIRATORY & CHEST PROCEDURES

Facility

$12,895.26

Service Code	APR-DRG 1213
Min. Negotiated Rate	$12,895.26
Max. Negotiated Rate	$12,895.26
Rate for Payer: AlohaCare Medicaid	$12,895.26
Rate for Payer: Hawaii Medical Service Association ABD	$12,895.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,895.26
Rate for Payer: Kaiser Permanente Medicaid	$12,895.26
Rate for Payer: Ohana Health Plan Medicaid	$12,895.26
Rate for Payer: UnitedHealthcare Medicaid	$12,895.26

OTHER RESPIRATORY & CHEST PROCEDURES

Facility

$22,069.04

Service Code	APR-DRG 1214
Min. Negotiated Rate	$22,069.04
Max. Negotiated Rate	$22,069.04
Rate for Payer: AlohaCare Medicaid	$22,069.04
Rate for Payer: Hawaii Medical Service Association ABD	$22,069.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22,069.04
Rate for Payer: Kaiser Permanente Medicaid	$22,069.04
Rate for Payer: Ohana Health Plan Medicaid	$22,069.04
Rate for Payer: UnitedHealthcare Medicaid	$22,069.04

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$7,375.45

Service Code	APR-DRG 1434
Min. Negotiated Rate	$7,375.45
Max. Negotiated Rate	$7,375.45
Rate for Payer: AlohaCare Medicaid	$7,375.45
Rate for Payer: Hawaii Medical Service Association ABD	$7,375.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,375.45
Rate for Payer: Kaiser Permanente Medicaid	$7,375.45
Rate for Payer: Ohana Health Plan Medicaid	$7,375.45
Rate for Payer: UnitedHealthcare Medicaid	$7,375.45

Know your out-of-pocket cost for care.

All Charges