Kona Community Hospital

All Charges

Charge

Type

Setting

Price

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$5,020.55

Service Code	APR-DRG 1433
Min. Negotiated Rate	$5,020.55
Max. Negotiated Rate	$5,020.55
Rate for Payer: AlohaCare Medicaid	$5,020.55
Rate for Payer: Hawaii Medical Service Association ABD	$5,020.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,020.55
Rate for Payer: Kaiser Permanente Medicaid	$5,020.55
Rate for Payer: Ohana Health Plan Medicaid	$5,020.55
Rate for Payer: UnitedHealthcare Medicaid	$5,020.55

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

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$2,546.58

Service Code	APR-DRG 1431
Min. Negotiated Rate	$2,546.58
Max. Negotiated Rate	$2,546.58
Rate for Payer: AlohaCare Medicaid	$2,546.58
Rate for Payer: Hawaii Medical Service Association ABD	$2,546.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,546.58
Rate for Payer: Kaiser Permanente Medicaid	$2,546.58
Rate for Payer: Ohana Health Plan Medicaid	$2,546.58
Rate for Payer: UnitedHealthcare Medicaid	$2,546.58

OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC

Facility

$31,584.75

Service Code	MSDRG 205
Min. Negotiated Rate	$20,804.34
Max. Negotiated Rate	$31,584.75
Rate for Payer: AlohaCare Medicare	$24,082.73
Rate for Payer: Devoted Health Medicare	$26,491.00
Rate for Payer: Hawaii Medical Service Association Commercial	$20,804.34
Rate for Payer: Hawaii Medical Service Association Medicare	$24,082.73
Rate for Payer: Humana Medicare	$24,082.73
Rate for Payer: Kaiser Permanente Commercial	$31,584.75
Rate for Payer: Kaiser Permanente Medicare	$24,082.73
Rate for Payer: Ohana Health Plan Medicare	$24,082.73
Rate for Payer: UnitedHealthcare Medicare	$24,082.73

OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC

Facility

$17,935.61

Service Code	MSDRG 206
Min. Negotiated Rate	$12,378.07
Max. Negotiated Rate	$17,935.61
Rate for Payer: AlohaCare Medicare	$12,378.07
Rate for Payer: Devoted Health Medicare	$13,615.88
Rate for Payer: Hawaii Medical Service Association Commercial	$17,935.61
Rate for Payer: Hawaii Medical Service Association Medicare	$12,378.07
Rate for Payer: Humana Medicare	$12,378.07
Rate for Payer: Kaiser Permanente Commercial	$16,233.98
Rate for Payer: Kaiser Permanente Medicare	$12,378.07
Rate for Payer: Ohana Health Plan Medicare	$12,378.07
Rate for Payer: UnitedHealthcare Medicare	$12,378.07

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC

Facility

$61,545.17

Service Code	MSDRG 167
Min. Negotiated Rate	$23,719.71
Max. Negotiated Rate	$61,545.17
Rate for Payer: AlohaCare Medicare	$23,719.71
Rate for Payer: Devoted Health Medicare	$26,091.68
Rate for Payer: Hawaii Medical Service Association Commercial	$61,545.17
Rate for Payer: Hawaii Medical Service Association Medicare	$23,719.71
Rate for Payer: Humana Medicare	$23,719.71
Rate for Payer: Kaiser Permanente Commercial	$31,108.65
Rate for Payer: Kaiser Permanente Medicare	$23,719.71
Rate for Payer: Ohana Health Plan Medicare	$23,719.71
Rate for Payer: UnitedHealthcare Medicare	$23,719.71

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC

Facility

$64,582.65

Service Code	MSDRG 166
Min. Negotiated Rate	$49,161.10
Max. Negotiated Rate	$64,582.65
Rate for Payer: AlohaCare Medicare	$49,161.10
Rate for Payer: Devoted Health Medicare	$54,077.21
Rate for Payer: Hawaii Medical Service Association Commercial	$64,582.65
Rate for Payer: Hawaii Medical Service Association Medicare	$49,161.10
Rate for Payer: Humana Medicare	$49,161.10
Rate for Payer: Kaiser Permanente Commercial	$64,475.32
Rate for Payer: Kaiser Permanente Medicare	$49,161.10
Rate for Payer: Ohana Health Plan Medicare	$49,161.10
Rate for Payer: UnitedHealthcare Medicare	$49,161.10

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$43,971.17

Service Code	MSDRG 168
Min. Negotiated Rate	$17,971.96
Max. Negotiated Rate	$43,971.17
Rate for Payer: AlohaCare Medicare	$17,971.96
Rate for Payer: Devoted Health Medicare	$19,769.16
Rate for Payer: Hawaii Medical Service Association Commercial	$43,971.17
Rate for Payer: Hawaii Medical Service Association Medicare	$17,971.96
Rate for Payer: Humana Medicare	$17,971.96
Rate for Payer: Kaiser Permanente Commercial	$23,570.40
Rate for Payer: Kaiser Permanente Medicare	$17,971.96
Rate for Payer: Ohana Health Plan Medicare	$17,971.96
Rate for Payer: UnitedHealthcare Medicare	$17,971.96

OTHER SIGNIFICANT HIP & FEMUR SURGERY

Facility

$20,882.04

Service Code	APR-DRG 3094
Min. Negotiated Rate	$20,882.04
Max. Negotiated Rate	$20,882.04
Rate for Payer: AlohaCare Medicaid	$20,882.04
Rate for Payer: Hawaii Medical Service Association ABD	$20,882.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20,882.04
Rate for Payer: Kaiser Permanente Medicaid	$20,882.04
Rate for Payer: Ohana Health Plan Medicaid	$20,882.04
Rate for Payer: UnitedHealthcare Medicaid	$20,882.04

OTHER SIGNIFICANT HIP & FEMUR SURGERY

Facility

$9,431.69

Service Code	APR-DRG 3092
Min. Negotiated Rate	$9,431.69
Max. Negotiated Rate	$9,431.69
Rate for Payer: AlohaCare Medicaid	$9,431.69
Rate for Payer: Hawaii Medical Service Association ABD	$9,431.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,431.69
Rate for Payer: Kaiser Permanente Medicaid	$9,431.69
Rate for Payer: Ohana Health Plan Medicaid	$9,431.69
Rate for Payer: UnitedHealthcare Medicaid	$9,431.69

OTHER SIGNIFICANT HIP & FEMUR SURGERY

Facility

$7,199.06

Service Code	APR-DRG 3091
Min. Negotiated Rate	$7,199.06
Max. Negotiated Rate	$7,199.06
Rate for Payer: AlohaCare Medicaid	$7,199.06
Rate for Payer: Hawaii Medical Service Association ABD	$7,199.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,199.06
Rate for Payer: Kaiser Permanente Medicaid	$7,199.06
Rate for Payer: Ohana Health Plan Medicaid	$7,199.06
Rate for Payer: UnitedHealthcare Medicaid	$7,199.06

OTHER SIGNIFICANT HIP & FEMUR SURGERY

Facility

$12,494.07

Service Code	APR-DRG 3093
Min. Negotiated Rate	$12,494.07
Max. Negotiated Rate	$12,494.07
Rate for Payer: AlohaCare Medicaid	$12,494.07
Rate for Payer: Hawaii Medical Service Association ABD	$12,494.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,494.07
Rate for Payer: Kaiser Permanente Medicaid	$12,494.07
Rate for Payer: Ohana Health Plan Medicaid	$12,494.07
Rate for Payer: UnitedHealthcare Medicaid	$12,494.07

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC

Facility

$29,808.00

Service Code	MSDRG 580
Min. Negotiated Rate	$22,727.97
Max. Negotiated Rate	$29,808.00
Rate for Payer: AlohaCare Medicare	$22,727.97
Rate for Payer: Devoted Health Medicare	$25,000.77
Rate for Payer: Hawaii Medical Service Association Commercial	$29,796.25
Rate for Payer: Hawaii Medical Service Association Medicare	$22,727.97
Rate for Payer: Humana Medicare	$22,727.97
Rate for Payer: Kaiser Permanente Commercial	$29,808.00
Rate for Payer: Kaiser Permanente Medicare	$22,727.97
Rate for Payer: Ohana Health Plan Medicare	$22,727.97
Rate for Payer: UnitedHealthcare Medicare	$22,727.97

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC

Facility

$55,864.12

Service Code	MSDRG 579
Min. Negotiated Rate	$42,595.24
Max. Negotiated Rate	$55,864.12
Rate for Payer: AlohaCare Medicare	$42,595.24
Rate for Payer: Devoted Health Medicare	$46,854.76
Rate for Payer: Hawaii Medical Service Association Commercial	$47,611.32
Rate for Payer: Hawaii Medical Service Association Medicare	$42,595.24
Rate for Payer: Humana Medicare	$42,595.24
Rate for Payer: Kaiser Permanente Commercial	$55,864.12
Rate for Payer: Kaiser Permanente Medicare	$42,595.24
Rate for Payer: Ohana Health Plan Medicare	$42,595.24
Rate for Payer: UnitedHealthcare Medicare	$42,595.24

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC

Facility

$24,893.47

Service Code	MSDRG 581
Min. Negotiated Rate	$18,980.76
Max. Negotiated Rate	$24,893.47
Rate for Payer: AlohaCare Medicare	$18,980.76
Rate for Payer: Devoted Health Medicare	$20,878.84
Rate for Payer: Hawaii Medical Service Association Commercial	$24,468.60
Rate for Payer: Hawaii Medical Service Association Medicare	$18,980.76
Rate for Payer: Humana Medicare	$18,980.76
Rate for Payer: Kaiser Permanente Commercial	$24,893.47
Rate for Payer: Kaiser Permanente Medicare	$18,980.76
Rate for Payer: Ohana Health Plan Medicare	$18,980.76
Rate for Payer: UnitedHealthcare Medicare	$18,980.76

OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS

Facility

$4,442.34

Service Code	APR-DRG 3853
Min. Negotiated Rate	$4,442.34
Max. Negotiated Rate	$4,442.34
Rate for Payer: AlohaCare Medicaid	$4,442.34
Rate for Payer: Hawaii Medical Service Association ABD	$4,442.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,442.34
Rate for Payer: Kaiser Permanente Medicaid	$4,442.34
Rate for Payer: Ohana Health Plan Medicaid	$4,442.34
Rate for Payer: UnitedHealthcare Medicaid	$4,442.34

OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS

Facility

$2,126.29

Service Code	APR-DRG 3851
Min. Negotiated Rate	$2,126.29
Max. Negotiated Rate	$2,126.29
Rate for Payer: AlohaCare Medicaid	$2,126.29
Rate for Payer: Hawaii Medical Service Association ABD	$2,126.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,126.29
Rate for Payer: Kaiser Permanente Medicaid	$2,126.29
Rate for Payer: Ohana Health Plan Medicaid	$2,126.29
Rate for Payer: UnitedHealthcare Medicaid	$2,126.29

OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS

Facility

$8,285.44

Service Code	APR-DRG 3854
Min. Negotiated Rate	$8,285.44
Max. Negotiated Rate	$8,285.44
Rate for Payer: AlohaCare Medicaid	$8,285.44
Rate for Payer: Hawaii Medical Service Association ABD	$8,285.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,285.44
Rate for Payer: Kaiser Permanente Medicaid	$8,285.44
Rate for Payer: Ohana Health Plan Medicaid	$8,285.44
Rate for Payer: UnitedHealthcare Medicaid	$8,285.44

OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS

Facility

$2,928.66

Service Code	APR-DRG 3852
Min. Negotiated Rate	$2,928.66
Max. Negotiated Rate	$2,928.66
Rate for Payer: AlohaCare Medicaid	$2,928.66
Rate for Payer: Hawaii Medical Service Association ABD	$2,928.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,928.66
Rate for Payer: Kaiser Permanente Medicaid	$2,928.66
Rate for Payer: Ohana Health Plan Medicaid	$2,928.66
Rate for Payer: UnitedHealthcare Medicaid	$2,928.66

OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES

Facility

$3,835.46

Service Code	APR-DRG 3641
Min. Negotiated Rate	$3,835.46
Max. Negotiated Rate	$3,835.46
Rate for Payer: AlohaCare Medicaid	$3,835.46
Rate for Payer: Hawaii Medical Service Association ABD	$3,835.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,835.46
Rate for Payer: Kaiser Permanente Medicaid	$3,835.46
Rate for Payer: Ohana Health Plan Medicaid	$3,835.46
Rate for Payer: UnitedHealthcare Medicaid	$3,835.46

OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES

Facility

$5,386.08

Service Code	APR-DRG 3642
Min. Negotiated Rate	$5,386.08
Max. Negotiated Rate	$5,386.08
Rate for Payer: AlohaCare Medicaid	$5,386.08
Rate for Payer: Hawaii Medical Service Association ABD	$5,386.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,386.08
Rate for Payer: Kaiser Permanente Medicaid	$5,386.08
Rate for Payer: Ohana Health Plan Medicaid	$5,386.08
Rate for Payer: UnitedHealthcare Medicaid	$5,386.08

OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES

Facility

$8,417.26

Service Code	APR-DRG 3643
Min. Negotiated Rate	$8,417.26
Max. Negotiated Rate	$8,417.26
Rate for Payer: AlohaCare Medicaid	$8,417.26
Rate for Payer: Hawaii Medical Service Association ABD	$8,417.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,417.26
Rate for Payer: Kaiser Permanente Medicaid	$8,417.26
Rate for Payer: Ohana Health Plan Medicaid	$8,417.26
Rate for Payer: UnitedHealthcare Medicaid	$8,417.26

OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES

Facility

$15,260.35

Service Code	APR-DRG 3644
Min. Negotiated Rate	$15,260.35
Max. Negotiated Rate	$15,260.35
Rate for Payer: AlohaCare Medicaid	$15,260.35
Rate for Payer: Hawaii Medical Service Association ABD	$15,260.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15,260.35
Rate for Payer: Kaiser Permanente Medicaid	$15,260.35
Rate for Payer: Ohana Health Plan Medicaid	$15,260.35
Rate for Payer: UnitedHealthcare Medicaid	$15,260.35

OTHER SMALL & LARGE BOWEL PROCEDURES

Facility

$5,559.29

Service Code	APR-DRG 2231
Min. Negotiated Rate	$5,559.29
Max. Negotiated Rate	$5,559.29
Rate for Payer: AlohaCare Medicaid	$5,559.29
Rate for Payer: Hawaii Medical Service Association ABD	$5,559.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,559.29
Rate for Payer: Kaiser Permanente Medicaid	$5,559.29
Rate for Payer: Ohana Health Plan Medicaid	$5,559.29
Rate for Payer: UnitedHealthcare Medicaid	$5,559.29

OTHER SMALL & LARGE BOWEL PROCEDURES

Facility

$20,054.20

Service Code	APR-DRG 2234
Min. Negotiated Rate	$20,054.20
Max. Negotiated Rate	$20,054.20
Rate for Payer: AlohaCare Medicaid	$20,054.20
Rate for Payer: Hawaii Medical Service Association ABD	$20,054.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20,054.20
Rate for Payer: Kaiser Permanente Medicaid	$20,054.20
Rate for Payer: Ohana Health Plan Medicaid	$20,054.20
Rate for Payer: UnitedHealthcare Medicaid	$20,054.20

Know your out-of-pocket cost for care.

All Charges