Kona Community Hospital

All Charges

Charge

Type

Setting

Price

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC

Facility

$67,186.21

Service Code	MSDRG 040
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$67,186.21
Rate for Payer: AlohaCare Medicare	$50,785.46
Rate for Payer: Devoted Health Medicare	$55,864.01
Rate for Payer: Hawaii Medical Service Association Commercial	$67,186.21
Rate for Payer: Hawaii Medical Service Association Medicare	$50,785.46
Rate for Payer: Humana Medicare	$50,785.46
Rate for Payer: Kaiser Permanente Commercial	$66,605.70
Rate for Payer: Kaiser Permanente Medicare	$50,785.46
Rate for Payer: Ohana Health Plan Medicare	$50,785.46
Rate for Payer: UnitedHealthcare Medicare	$50,785.46
Rate for Payer: University Health Alliance Commercial	$10,400.00

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC

Facility

$50,962.20

Service Code	MSDRG 042
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$50,962.20
Rate for Payer: AlohaCare Medicare	$22,724.04
Rate for Payer: Devoted Health Medicare	$24,996.44
Rate for Payer: Hawaii Medical Service Association Commercial	$50,962.20
Rate for Payer: Hawaii Medical Service Association Medicare	$22,724.04
Rate for Payer: Humana Medicare	$22,724.04
Rate for Payer: Kaiser Permanente Commercial	$29,802.83
Rate for Payer: Kaiser Permanente Medicare	$22,724.04
Rate for Payer: Ohana Health Plan Medicare	$22,724.04
Rate for Payer: UnitedHealthcare Medicare	$22,724.04
Rate for Payer: University Health Alliance Commercial	$10,400.00

PERIPHERAL & OTHER VASCULAR DISORDERS

Facility

$4,563.97

Service Code	APR-DRG 1973
Min. Negotiated Rate	$4,563.97
Max. Negotiated Rate	$4,563.97
Rate for Payer: AlohaCare Medicaid	$4,563.97
Rate for Payer: Hawaii Medical Service Association ABD	$4,563.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,563.97
Rate for Payer: Kaiser Permanente Medicaid	$4,563.97
Rate for Payer: Ohana Health Plan Medicaid	$4,563.97
Rate for Payer: UnitedHealthcare Medicaid	$4,563.97

PERIPHERAL & OTHER VASCULAR DISORDERS

Facility

$2,504.55

Service Code	APR-DRG 1971
Min. Negotiated Rate	$2,504.55
Max. Negotiated Rate	$2,504.55
Rate for Payer: AlohaCare Medicaid	$2,504.55
Rate for Payer: Hawaii Medical Service Association ABD	$2,504.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,504.55
Rate for Payer: Kaiser Permanente Medicaid	$2,504.55
Rate for Payer: Ohana Health Plan Medicaid	$2,504.55
Rate for Payer: UnitedHealthcare Medicaid	$2,504.55

PERIPHERAL & OTHER VASCULAR DISORDERS

Facility

$8,064.47

Service Code	APR-DRG 1974
Min. Negotiated Rate	$8,064.47
Max. Negotiated Rate	$8,064.47
Rate for Payer: AlohaCare Medicaid	$8,064.47
Rate for Payer: Hawaii Medical Service Association ABD	$8,064.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,064.47
Rate for Payer: Kaiser Permanente Medicaid	$8,064.47
Rate for Payer: Ohana Health Plan Medicaid	$8,064.47
Rate for Payer: UnitedHealthcare Medicaid	$8,064.47

PERIPHERAL & OTHER VASCULAR DISORDERS

Facility

$3,301.19

Service Code	APR-DRG 1972
Min. Negotiated Rate	$3,301.19
Max. Negotiated Rate	$3,301.19
Rate for Payer: AlohaCare Medicaid	$3,301.19
Rate for Payer: Hawaii Medical Service Association ABD	$3,301.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,301.19
Rate for Payer: Kaiser Permanente Medicaid	$3,301.19
Rate for Payer: Ohana Health Plan Medicaid	$3,301.19
Rate for Payer: UnitedHealthcare Medicaid	$3,301.19

PERIPHERAL VASCULAR DISORDERS WITH CC

Facility

$24,950.74

Service Code	MSDRG 300
Min. Negotiated Rate	$14,040.57
Max. Negotiated Rate	$24,950.74
Rate for Payer: AlohaCare Medicare	$14,040.57
Rate for Payer: Devoted Health Medicare	$15,444.63
Rate for Payer: Hawaii Medical Service Association Commercial	$24,950.74
Rate for Payer: Hawaii Medical Service Association Medicare	$14,040.57
Rate for Payer: Humana Medicare	$14,040.57
Rate for Payer: Kaiser Permanente Commercial	$18,414.38
Rate for Payer: Kaiser Permanente Medicare	$14,040.57
Rate for Payer: Ohana Health Plan Medicare	$14,040.57
Rate for Payer: UnitedHealthcare Medicare	$14,040.57

PERIPHERAL VASCULAR DISORDERS WITH MCC

Facility

$28,164.08

Service Code	MSDRG 299
Min. Negotiated Rate	$21,474.53
Max. Negotiated Rate	$28,164.08
Rate for Payer: AlohaCare Medicare	$21,474.53
Rate for Payer: Devoted Health Medicare	$23,621.98
Rate for Payer: Hawaii Medical Service Association Commercial	$26,469.49
Rate for Payer: Hawaii Medical Service Association Medicare	$21,474.53
Rate for Payer: Humana Medicare	$21,474.53
Rate for Payer: Kaiser Permanente Commercial	$28,164.08
Rate for Payer: Kaiser Permanente Medicare	$21,474.53
Rate for Payer: Ohana Health Plan Medicare	$21,474.53
Rate for Payer: UnitedHealthcare Medicare	$21,474.53

PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC

Facility

$18,369.53

Service Code	MSDRG 301
Min. Negotiated Rate	$9,466.04
Max. Negotiated Rate	$18,369.53
Rate for Payer: AlohaCare Medicare	$9,466.04
Rate for Payer: Devoted Health Medicare	$10,412.64
Rate for Payer: Hawaii Medical Service Association Commercial	$18,369.53
Rate for Payer: Hawaii Medical Service Association Medicare	$9,466.04
Rate for Payer: Humana Medicare	$9,466.04
Rate for Payer: Kaiser Permanente Commercial	$12,414.83
Rate for Payer: Kaiser Permanente Medicare	$9,466.04
Rate for Payer: Ohana Health Plan Medicare	$9,466.04
Rate for Payer: UnitedHealthcare Medicare	$9,466.04

PERITONEAL ADHESIOLYSIS

Facility

$8,614.67

Service Code	APR-DRG 2242
Min. Negotiated Rate	$8,614.67
Max. Negotiated Rate	$8,614.67
Rate for Payer: AlohaCare Medicaid	$8,614.67
Rate for Payer: Hawaii Medical Service Association ABD	$8,614.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,614.67
Rate for Payer: Kaiser Permanente Medicaid	$8,614.67
Rate for Payer: Ohana Health Plan Medicaid	$8,614.67
Rate for Payer: UnitedHealthcare Medicaid	$8,614.67

PERITONEAL ADHESIOLYSIS

Facility

$20,584.02

Service Code	APR-DRG 2244
Min. Negotiated Rate	$20,584.02
Max. Negotiated Rate	$20,584.02
Rate for Payer: AlohaCare Medicaid	$20,584.02
Rate for Payer: Hawaii Medical Service Association ABD	$20,584.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20,584.02
Rate for Payer: Kaiser Permanente Medicaid	$20,584.02
Rate for Payer: Ohana Health Plan Medicaid	$20,584.02
Rate for Payer: UnitedHealthcare Medicaid	$20,584.02

PERITONEAL ADHESIOLYSIS

Facility

$6,900.40

Service Code	APR-DRG 2241
Min. Negotiated Rate	$6,900.40
Max. Negotiated Rate	$6,900.40
Rate for Payer: AlohaCare Medicaid	$6,900.40
Rate for Payer: Hawaii Medical Service Association ABD	$6,900.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,900.40
Rate for Payer: Kaiser Permanente Medicaid	$6,900.40
Rate for Payer: Ohana Health Plan Medicaid	$6,900.40
Rate for Payer: UnitedHealthcare Medicaid	$6,900.40

PERITONEAL ADHESIOLYSIS

Facility

$12,453.32

Service Code	APR-DRG 2243
Min. Negotiated Rate	$12,453.32
Max. Negotiated Rate	$12,453.32
Rate for Payer: AlohaCare Medicaid	$12,453.32
Rate for Payer: Hawaii Medical Service Association ABD	$12,453.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,453.32
Rate for Payer: Kaiser Permanente Medicaid	$12,453.32
Rate for Payer: Ohana Health Plan Medicaid	$12,453.32
Rate for Payer: UnitedHealthcare Medicaid	$12,453.32

PERITONEAL ADHESIOLYSIS WITH CC

Facility

$54,313.07

Service Code	MSDRG 336
Min. Negotiated Rate	$27,735.24
Max. Negotiated Rate	$54,313.07
Rate for Payer: AlohaCare Medicare	$27,735.24
Rate for Payer: Devoted Health Medicare	$30,508.76
Rate for Payer: Hawaii Medical Service Association Commercial	$54,313.07
Rate for Payer: Hawaii Medical Service Association Medicare	$27,735.24
Rate for Payer: Humana Medicare	$27,735.24
Rate for Payer: Kaiser Permanente Commercial	$36,375.07
Rate for Payer: Kaiser Permanente Medicare	$27,735.24
Rate for Payer: Ohana Health Plan Medicare	$27,735.24
Rate for Payer: UnitedHealthcare Medicare	$27,735.24

PERITONEAL ADHESIOLYSIS WITH MCC

Facility

$61,598.03

Service Code	MSDRG 335
Min. Negotiated Rate	$46,967.21
Max. Negotiated Rate	$61,598.03
Rate for Payer: AlohaCare Medicare	$46,967.21
Rate for Payer: Devoted Health Medicare	$51,663.93
Rate for Payer: Hawaii Medical Service Association Commercial	$61,448.74
Rate for Payer: Hawaii Medical Service Association Medicare	$46,967.21
Rate for Payer: Humana Medicare	$46,967.21
Rate for Payer: Kaiser Permanente Commercial	$61,598.03
Rate for Payer: Kaiser Permanente Medicare	$46,967.21
Rate for Payer: Ohana Health Plan Medicare	$46,967.21
Rate for Payer: UnitedHealthcare Medicare	$46,967.21

PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC

Facility

$33,339.98

Service Code	MSDRG 337
Min. Negotiated Rate	$20,189.51
Max. Negotiated Rate	$33,339.98
Rate for Payer: AlohaCare Medicare	$20,189.51
Rate for Payer: Devoted Health Medicare	$22,208.46
Rate for Payer: Hawaii Medical Service Association Commercial	$33,339.98
Rate for Payer: Hawaii Medical Service Association Medicare	$20,189.51
Rate for Payer: Humana Medicare	$20,189.51
Rate for Payer: Kaiser Permanente Commercial	$26,478.75
Rate for Payer: Kaiser Permanente Medicare	$20,189.51
Rate for Payer: Ohana Health Plan Medicare	$20,189.51
Rate for Payer: UnitedHealthcare Medicare	$20,189.51

PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK

Facility

$11,681.51

Service Code	APR-DRG 1702
Min. Negotiated Rate	$11,681.51
Max. Negotiated Rate	$11,681.51
Rate for Payer: AlohaCare Medicaid	$11,681.51
Rate for Payer: Hawaii Medical Service Association ABD	$11,681.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,681.51
Rate for Payer: Kaiser Permanente Medicaid	$11,681.51
Rate for Payer: Ohana Health Plan Medicaid	$11,681.51
Rate for Payer: UnitedHealthcare Medicaid	$11,681.51

PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK

Facility

$19,990.52

Service Code	APR-DRG 1704
Min. Negotiated Rate	$19,990.52
Max. Negotiated Rate	$19,990.52
Rate for Payer: AlohaCare Medicaid	$19,990.52
Rate for Payer: Hawaii Medical Service Association ABD	$19,990.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19,990.52
Rate for Payer: Kaiser Permanente Medicaid	$19,990.52
Rate for Payer: Ohana Health Plan Medicaid	$19,990.52
Rate for Payer: UnitedHealthcare Medicaid	$19,990.52

PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK

Facility

$10,557.56

Service Code	APR-DRG 1701
Min. Negotiated Rate	$10,557.56
Max. Negotiated Rate	$10,557.56
Rate for Payer: AlohaCare Medicaid	$10,557.56
Rate for Payer: Hawaii Medical Service Association ABD	$10,557.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,557.56
Rate for Payer: Kaiser Permanente Medicaid	$10,557.56
Rate for Payer: Ohana Health Plan Medicaid	$10,557.56
Rate for Payer: UnitedHealthcare Medicaid	$10,557.56

PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK

Facility

$14,396.21

Service Code	APR-DRG 1703
Min. Negotiated Rate	$14,396.21
Max. Negotiated Rate	$14,396.21
Rate for Payer: AlohaCare Medicaid	$14,396.21
Rate for Payer: Hawaii Medical Service Association ABD	$14,396.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14,396.21
Rate for Payer: Kaiser Permanente Medicaid	$14,396.21
Rate for Payer: Ohana Health Plan Medicaid	$14,396.21
Rate for Payer: UnitedHealthcare Medicaid	$14,396.21

PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC

Facility

$54,433.61

Service Code	MSDRG 243
Min. Negotiated Rate	$28,027.23
Max. Negotiated Rate	$54,433.61
Rate for Payer: AlohaCare Medicare	$28,027.23
Rate for Payer: Devoted Health Medicare	$30,829.95
Rate for Payer: Hawaii Medical Service Association Commercial	$54,433.61
Rate for Payer: Hawaii Medical Service Association Medicare	$28,027.23
Rate for Payer: Humana Medicare	$28,027.23
Rate for Payer: Kaiser Permanente Commercial	$36,758.03
Rate for Payer: Kaiser Permanente Medicare	$28,027.23
Rate for Payer: Ohana Health Plan Medicare	$28,027.23
Rate for Payer: UnitedHealthcare Medicare	$28,027.23

PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC

Facility

$72,803.14

Service Code	MSDRG 242
Min. Negotiated Rate	$41,994.17
Max. Negotiated Rate	$72,803.14
Rate for Payer: AlohaCare Medicare	$41,994.17
Rate for Payer: Devoted Health Medicare	$46,193.59
Rate for Payer: Hawaii Medical Service Association Commercial	$72,803.14
Rate for Payer: Hawaii Medical Service Association Medicare	$41,994.17
Rate for Payer: Humana Medicare	$41,994.17
Rate for Payer: Kaiser Permanente Commercial	$55,075.80
Rate for Payer: Kaiser Permanente Medicare	$41,994.17
Rate for Payer: Ohana Health Plan Medicare	$41,994.17
Rate for Payer: UnitedHealthcare Medicare	$41,994.17

PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC

Facility

$44,718.49

Service Code	MSDRG 244
Min. Negotiated Rate	$23,773.62
Max. Negotiated Rate	$44,718.49
Rate for Payer: AlohaCare Medicare	$23,773.62
Rate for Payer: Devoted Health Medicare	$26,150.98
Rate for Payer: Hawaii Medical Service Association Commercial	$44,718.49
Rate for Payer: Hawaii Medical Service Association Medicare	$23,773.62
Rate for Payer: Humana Medicare	$23,773.62
Rate for Payer: Kaiser Permanente Commercial	$31,179.38
Rate for Payer: Kaiser Permanente Medicare	$23,773.62
Rate for Payer: Ohana Health Plan Medicare	$23,773.62
Rate for Payer: UnitedHealthcare Medicare	$23,773.62

PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK

Facility

$17,817.11

Service Code	APR-DRG 1714
Min. Negotiated Rate	$17,817.11
Max. Negotiated Rate	$17,817.11
Rate for Payer: AlohaCare Medicaid	$17,817.11
Rate for Payer: Hawaii Medical Service Association ABD	$17,817.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17,817.11
Rate for Payer: Kaiser Permanente Medicaid	$17,817.11
Rate for Payer: Ohana Health Plan Medicaid	$17,817.11
Rate for Payer: UnitedHealthcare Medicaid	$17,817.11

PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK

Facility

$11,873.19

Service Code	APR-DRG 1713
Min. Negotiated Rate	$11,873.19
Max. Negotiated Rate	$11,873.19
Rate for Payer: AlohaCare Medicaid	$11,873.19
Rate for Payer: Hawaii Medical Service Association ABD	$11,873.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,873.19
Rate for Payer: Kaiser Permanente Medicaid	$11,873.19
Rate for Payer: Ohana Health Plan Medicaid	$11,873.19
Rate for Payer: UnitedHealthcare Medicaid	$11,873.19

Know your out-of-pocket cost for care.

All Charges