Kona Community Hospital

All Charges

Charge

Type

Setting

Price

RESPIRATORY FAILURE

Facility

$3,972.38

Service Code	APR-DRG 1332
Min. Negotiated Rate	$3,972.38
Max. Negotiated Rate	$3,972.38
Rate for Payer: AlohaCare Medicaid	$3,972.38
Rate for Payer: Hawaii Medical Service Association ABD	$3,972.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,972.38
Rate for Payer: Kaiser Permanente Medicaid	$3,972.38
Rate for Payer: Ohana Health Plan Medicaid	$3,972.38
Rate for Payer: UnitedHealthcare Medicaid	$3,972.38

RESPIRATORY FAILURE

Facility

$2,170.86

Service Code	APR-DRG 1331
Min. Negotiated Rate	$2,170.86
Max. Negotiated Rate	$2,170.86
Rate for Payer: AlohaCare Medicaid	$2,170.86
Rate for Payer: Hawaii Medical Service Association ABD	$2,170.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,170.86
Rate for Payer: Kaiser Permanente Medicaid	$2,170.86
Rate for Payer: Ohana Health Plan Medicaid	$2,170.86
Rate for Payer: UnitedHealthcare Medicaid	$2,170.86

RESPIRATORY FAILURE

Facility

$5,777.71

Service Code	APR-DRG 1333
Min. Negotiated Rate	$5,777.71
Max. Negotiated Rate	$5,777.71
Rate for Payer: AlohaCare Medicaid	$5,777.71
Rate for Payer: Hawaii Medical Service Association ABD	$5,777.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,777.71
Rate for Payer: Kaiser Permanente Medicaid	$5,777.71
Rate for Payer: Ohana Health Plan Medicaid	$5,777.71
Rate for Payer: UnitedHealthcare Medicaid	$5,777.71

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC

Facility

$42,862.25

Service Code	MSDRG 178
Min. Negotiated Rate	$12,837.09
Max. Negotiated Rate	$42,862.25
Rate for Payer: AlohaCare Medicare	$12,837.09
Rate for Payer: Devoted Health Medicare	$14,120.80
Rate for Payer: Hawaii Medical Service Association Commercial	$42,862.25
Rate for Payer: Hawaii Medical Service Association Medicare	$12,837.09
Rate for Payer: Humana Medicare	$12,837.09
Rate for Payer: Kaiser Permanente Commercial	$16,836.00
Rate for Payer: Kaiser Permanente Medicare	$12,837.09
Rate for Payer: Ohana Health Plan Medicare	$12,837.09
Rate for Payer: UnitedHealthcare Medicare	$12,837.09

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC

Facility

$42,862.25

Service Code	MSDRG 177
Min. Negotiated Rate	$20,553.84
Max. Negotiated Rate	$42,862.25
Rate for Payer: AlohaCare Medicare	$20,553.84
Rate for Payer: Devoted Health Medicare	$22,609.22
Rate for Payer: Hawaii Medical Service Association Commercial	$42,862.25
Rate for Payer: Hawaii Medical Service Association Medicare	$20,553.84
Rate for Payer: Humana Medicare	$20,553.84
Rate for Payer: Kaiser Permanente Commercial	$26,956.58
Rate for Payer: Kaiser Permanente Medicare	$20,553.84
Rate for Payer: Ohana Health Plan Medicare	$20,553.84
Rate for Payer: UnitedHealthcare Medicare	$20,553.84

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC

Facility

$33,846.23

Service Code	MSDRG 179
Min. Negotiated Rate	$9,930.32
Max. Negotiated Rate	$33,846.23
Rate for Payer: AlohaCare Medicare	$9,930.32
Rate for Payer: Devoted Health Medicare	$10,923.35
Rate for Payer: Hawaii Medical Service Association Commercial	$33,846.23
Rate for Payer: Hawaii Medical Service Association Medicare	$9,930.32
Rate for Payer: Humana Medicare	$9,930.32
Rate for Payer: Kaiser Permanente Commercial	$13,023.75
Rate for Payer: Kaiser Permanente Medicare	$9,930.32
Rate for Payer: Ohana Health Plan Medicare	$9,930.32
Rate for Payer: UnitedHealthcare Medicare	$9,930.32

RESPIRATORY MALIGNANCY

Facility

$4,441.70

Service Code	APR-DRG 1362
Min. Negotiated Rate	$4,441.70
Max. Negotiated Rate	$4,441.70
Rate for Payer: AlohaCare Medicaid	$4,441.70
Rate for Payer: Hawaii Medical Service Association ABD	$4,441.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,441.70
Rate for Payer: Kaiser Permanente Medicaid	$4,441.70
Rate for Payer: Ohana Health Plan Medicaid	$4,441.70
Rate for Payer: UnitedHealthcare Medicaid	$4,441.70

RESPIRATORY MALIGNANCY

Facility

$8,666.89

Service Code	APR-DRG 1364
Min. Negotiated Rate	$8,666.89
Max. Negotiated Rate	$8,666.89
Rate for Payer: AlohaCare Medicaid	$8,666.89
Rate for Payer: Hawaii Medical Service Association ABD	$8,666.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,666.89
Rate for Payer: Kaiser Permanente Medicaid	$8,666.89
Rate for Payer: Ohana Health Plan Medicaid	$8,666.89
Rate for Payer: UnitedHealthcare Medicaid	$8,666.89

RESPIRATORY MALIGNANCY

Facility

$6,112.04

Service Code	APR-DRG 1363
Min. Negotiated Rate	$6,112.04
Max. Negotiated Rate	$6,112.04
Rate for Payer: AlohaCare Medicaid	$6,112.04
Rate for Payer: Hawaii Medical Service Association ABD	$6,112.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,112.04
Rate for Payer: Kaiser Permanente Medicaid	$6,112.04
Rate for Payer: Ohana Health Plan Medicaid	$6,112.04
Rate for Payer: UnitedHealthcare Medicaid	$6,112.04

RESPIRATORY MALIGNANCY

Facility

$4,015.04

Service Code	APR-DRG 1361
Min. Negotiated Rate	$4,015.04
Max. Negotiated Rate	$4,015.04
Rate for Payer: AlohaCare Medicaid	$4,015.04
Rate for Payer: Hawaii Medical Service Association ABD	$4,015.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,015.04
Rate for Payer: Kaiser Permanente Medicaid	$4,015.04
Rate for Payer: Ohana Health Plan Medicaid	$4,015.04
Rate for Payer: UnitedHealthcare Medicaid	$4,015.04

RESPIRATORY NEOPLASMS WITH CC

Facility

$36,546.21

Service Code	MSDRG 181
Min. Negotiated Rate	$14,086.61
Max. Negotiated Rate	$36,546.21
Rate for Payer: AlohaCare Medicare	$14,086.61
Rate for Payer: Devoted Health Medicare	$15,495.27
Rate for Payer: Hawaii Medical Service Association Commercial	$36,546.21
Rate for Payer: Hawaii Medical Service Association Medicare	$14,086.61
Rate for Payer: Humana Medicare	$14,086.61
Rate for Payer: Kaiser Permanente Commercial	$18,474.75
Rate for Payer: Kaiser Permanente Medicare	$14,086.61
Rate for Payer: Ohana Health Plan Medicare	$14,086.61
Rate for Payer: UnitedHealthcare Medicare	$14,086.61

RESPIRATORY NEOPLASMS WITH MCC

Facility

$36,546.21

Service Code	MSDRG 180
Min. Negotiated Rate	$23,227.78
Max. Negotiated Rate	$36,546.21
Rate for Payer: AlohaCare Medicare	$23,227.78
Rate for Payer: Devoted Health Medicare	$25,550.56
Rate for Payer: Hawaii Medical Service Association Commercial	$36,546.21
Rate for Payer: Hawaii Medical Service Association Medicare	$23,227.78
Rate for Payer: Humana Medicare	$23,227.78
Rate for Payer: Kaiser Permanente Commercial	$30,463.50
Rate for Payer: Kaiser Permanente Medicare	$23,227.78
Rate for Payer: Ohana Health Plan Medicare	$23,227.78
Rate for Payer: UnitedHealthcare Medicare	$23,227.78

RESPIRATORY NEOPLASMS WITHOUT CC/MCC

Facility

$36,546.21

Service Code	MSDRG 182
Min. Negotiated Rate	$9,914.54
Max. Negotiated Rate	$36,546.21
Rate for Payer: AlohaCare Medicare	$9,914.54
Rate for Payer: Devoted Health Medicare	$10,905.99
Rate for Payer: Hawaii Medical Service Association Commercial	$36,546.21
Rate for Payer: Hawaii Medical Service Association Medicare	$9,914.54
Rate for Payer: Humana Medicare	$9,914.54
Rate for Payer: Kaiser Permanente Commercial	$12,834.00
Rate for Payer: Kaiser Permanente Medicare	$9,914.54
Rate for Payer: Ohana Health Plan Medicare	$9,914.54
Rate for Payer: UnitedHealthcare Medicare	$9,914.54

RESPIRATORY SIGNS AND SYMPTOMS

Facility

$13,927.65

Service Code	MSDRG 204
Min. Negotiated Rate	$10,619.54
Max. Negotiated Rate	$13,927.65
Rate for Payer: AlohaCare Medicare	$10,619.54
Rate for Payer: Devoted Health Medicare	$11,681.49
Rate for Payer: Hawaii Medical Service Association Commercial	$13,716.88
Rate for Payer: Hawaii Medical Service Association Medicare	$10,619.54
Rate for Payer: Humana Medicare	$10,619.54
Rate for Payer: Kaiser Permanente Commercial	$13,927.65
Rate for Payer: Kaiser Permanente Medicare	$10,619.54
Rate for Payer: Ohana Health Plan Medicare	$10,619.54
Rate for Payer: UnitedHealthcare Medicare	$10,619.54

RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$4,583.07

Service Code	APR-DRG 1443
Min. Negotiated Rate	$4,583.07
Max. Negotiated Rate	$4,583.07
Rate for Payer: AlohaCare Medicaid	$4,583.07
Rate for Payer: Hawaii Medical Service Association ABD	$4,583.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,583.07
Rate for Payer: Kaiser Permanente Medicaid	$4,583.07
Rate for Payer: Ohana Health Plan Medicaid	$4,583.07
Rate for Payer: UnitedHealthcare Medicaid	$4,583.07

RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$7,351.89

Service Code	APR-DRG 1444
Min. Negotiated Rate	$7,351.89
Max. Negotiated Rate	$7,351.89
Rate for Payer: AlohaCare Medicaid	$7,351.89
Rate for Payer: Hawaii Medical Service Association ABD	$7,351.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,351.89
Rate for Payer: Kaiser Permanente Medicaid	$7,351.89
Rate for Payer: Ohana Health Plan Medicaid	$7,351.89
Rate for Payer: UnitedHealthcare Medicaid	$7,351.89

RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$3,294.18

Service Code	APR-DRG 1442
Min. Negotiated Rate	$3,294.18
Max. Negotiated Rate	$3,294.18
Rate for Payer: AlohaCare Medicaid	$3,294.18
Rate for Payer: Hawaii Medical Service Association ABD	$3,294.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,294.18
Rate for Payer: Kaiser Permanente Medicaid	$3,294.18
Rate for Payer: Ohana Health Plan Medicaid	$3,294.18
Rate for Payer: UnitedHealthcare Medicaid	$3,294.18

RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$2,513.46

Service Code	APR-DRG 1441
Min. Negotiated Rate	$2,513.46
Max. Negotiated Rate	$2,513.46
Rate for Payer: AlohaCare Medicaid	$2,513.46
Rate for Payer: Hawaii Medical Service Association ABD	$2,513.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,513.46
Rate for Payer: Kaiser Permanente Medicaid	$2,513.46
Rate for Payer: Ohana Health Plan Medicaid	$2,513.46
Rate for Payer: UnitedHealthcare Medicaid	$2,513.46

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS

Facility

$71,404.93

Service Code	MSDRG 208
Min. Negotiated Rate	$36,153.00
Max. Negotiated Rate	$71,404.93
Rate for Payer: AlohaCare Medicare	$36,153.00
Rate for Payer: Devoted Health Medicare	$39,768.30
Rate for Payer: Hawaii Medical Service Association Commercial	$71,404.93
Rate for Payer: Hawaii Medical Service Association Medicare	$36,153.00
Rate for Payer: Humana Medicare	$36,153.00
Rate for Payer: Kaiser Permanente Commercial	$47,415.07
Rate for Payer: Kaiser Permanente Medicare	$36,153.00
Rate for Payer: Ohana Health Plan Medicare	$36,153.00
Rate for Payer: UnitedHealthcare Medicare	$36,153.00

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS

Facility

$188,396.20

Service Code	MSDRG 207
Min. Negotiated Rate	$84,634.10
Max. Negotiated Rate	$188,396.20
Rate for Payer: AlohaCare Medicare	$84,634.10
Rate for Payer: Devoted Health Medicare	$93,097.51
Rate for Payer: Hawaii Medical Service Association Commercial	$188,396.20
Rate for Payer: Hawaii Medical Service Association Medicare	$84,634.10
Rate for Payer: Humana Medicare	$84,634.10
Rate for Payer: Kaiser Permanente Commercial	$110,998.57
Rate for Payer: Kaiser Permanente Medicare	$84,634.10
Rate for Payer: Ohana Health Plan Medicare	$84,634.10
Rate for Payer: UnitedHealthcare Medicare	$84,634.10

RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

Facility

$17,329.96

Service Code	APR-DRG 1302
Min. Negotiated Rate	$17,329.96
Max. Negotiated Rate	$17,329.96
Rate for Payer: AlohaCare Medicaid	$17,329.96
Rate for Payer: Hawaii Medical Service Association ABD	$17,329.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17,329.96
Rate for Payer: Kaiser Permanente Medicaid	$17,329.96
Rate for Payer: Ohana Health Plan Medicaid	$17,329.96
Rate for Payer: UnitedHealthcare Medicaid	$17,329.96

RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

Facility

$20,588.48

Service Code	APR-DRG 1303
Min. Negotiated Rate	$20,588.48
Max. Negotiated Rate	$20,588.48
Rate for Payer: AlohaCare Medicaid	$20,588.48
Rate for Payer: Hawaii Medical Service Association ABD	$20,588.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20,588.48
Rate for Payer: Kaiser Permanente Medicaid	$20,588.48
Rate for Payer: Ohana Health Plan Medicaid	$20,588.48
Rate for Payer: UnitedHealthcare Medicaid	$20,588.48

RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

Facility

$17,040.21

Service Code	APR-DRG 1301
Min. Negotiated Rate	$17,040.21
Max. Negotiated Rate	$17,040.21
Rate for Payer: AlohaCare Medicaid	$17,040.21
Rate for Payer: Hawaii Medical Service Association ABD	$17,040.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17,040.21
Rate for Payer: Kaiser Permanente Medicaid	$17,040.21
Rate for Payer: Ohana Health Plan Medicaid	$17,040.21
Rate for Payer: UnitedHealthcare Medicaid	$17,040.21

RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

Facility

$26,260.48

Service Code	APR-DRG 1304
Min. Negotiated Rate	$26,260.48
Max. Negotiated Rate	$26,260.48
Rate for Payer: AlohaCare Medicaid	$26,260.48
Rate for Payer: Hawaii Medical Service Association ABD	$26,260.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26,260.48
Rate for Payer: Kaiser Permanente Medicaid	$26,260.48
Rate for Payer: Ohana Health Plan Medicaid	$26,260.48
Rate for Payer: UnitedHealthcare Medicaid	$26,260.48

Restor Prevena 14 Day Pump Pre4010 [3643807]

Facility

$2,496.25

Hospital Charge Code	3643807
Hospital Revenue Code	272
Min. Negotiated Rate	$1,273.09
Max. Negotiated Rate	$2,421.36
Rate for Payer: Cash Price	$1,622.56
Rate for Payer: Hawaii Western Management Group Commercial	$2,371.44
Rate for Payer: Health Management Network Commercial	$2,121.81
Rate for Payer: Kaiser Permanente Commercial	$1,572.64
Rate for Payer: Kaiser Permanente Medicaid	$1,273.09
Rate for Payer: MDX Hawaii PPO	$2,421.36
Rate for Payer: University Health Alliance Commercial	$1,819.52

Know your out-of-pocket cost for care.

All Charges