Kona Community Hospital

All Charges

Charge

Type

Setting

Price

CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE

Facility

$10,388.17

Service Code	APR-DRG 1914
Min. Negotiated Rate	$10,388.17
Max. Negotiated Rate	$10,388.17
Rate for Payer: AlohaCare Medicaid	$10,388.17
Rate for Payer: Hawaii Medical Service Association ABD	$10,388.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,388.17
Rate for Payer: Kaiser Permanente Medicaid	$10,388.17
Rate for Payer: Ohana Health Plan Medicaid	$10,388.17
Rate for Payer: UnitedHealthcare Medicaid	$10,388.17

CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE

Facility

$4,748.00

Service Code	APR-DRG 1911
Min. Negotiated Rate	$4,748.00
Max. Negotiated Rate	$4,748.00
Rate for Payer: AlohaCare Medicaid	$4,748.00
Rate for Payer: Hawaii Medical Service Association ABD	$4,748.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,748.00
Rate for Payer: Kaiser Permanente Medicaid	$4,748.00
Rate for Payer: Ohana Health Plan Medicaid	$4,748.00
Rate for Payer: UnitedHealthcare Medicaid	$4,748.00

CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE

Facility

$7,032.85

Service Code	APR-DRG 1913
Min. Negotiated Rate	$7,032.85
Max. Negotiated Rate	$7,032.85
Rate for Payer: AlohaCare Medicaid	$7,032.85
Rate for Payer: Hawaii Medical Service Association ABD	$7,032.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,032.85
Rate for Payer: Kaiser Permanente Medicaid	$7,032.85
Rate for Payer: Ohana Health Plan Medicaid	$7,032.85
Rate for Payer: UnitedHealthcare Medicaid	$7,032.85

CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE

Facility

$5,455.49

Service Code	APR-DRG 1912
Min. Negotiated Rate	$5,455.49
Max. Negotiated Rate	$5,455.49
Rate for Payer: AlohaCare Medicaid	$5,455.49
Rate for Payer: Hawaii Medical Service Association ABD	$5,455.49
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,455.49
Rate for Payer: Kaiser Permanente Medicaid	$5,455.49
Rate for Payer: Ohana Health Plan Medicaid	$5,455.49
Rate for Payer: UnitedHealthcare Medicaid	$5,455.49

CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS

Facility

$6,255.32

Service Code	APR-DRG 1922
Min. Negotiated Rate	$6,255.32
Max. Negotiated Rate	$6,255.32
Rate for Payer: AlohaCare Medicaid	$6,255.32
Rate for Payer: Hawaii Medical Service Association ABD	$6,255.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,255.32
Rate for Payer: Kaiser Permanente Medicaid	$6,255.32
Rate for Payer: Ohana Health Plan Medicaid	$6,255.32
Rate for Payer: UnitedHealthcare Medicaid	$6,255.32

CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS

Facility

$8,818.45

Service Code	APR-DRG 1923
Min. Negotiated Rate	$8,818.45
Max. Negotiated Rate	$8,818.45
Rate for Payer: AlohaCare Medicaid	$8,818.45
Rate for Payer: Hawaii Medical Service Association ABD	$8,818.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,818.45
Rate for Payer: Kaiser Permanente Medicaid	$8,818.45
Rate for Payer: Ohana Health Plan Medicaid	$8,818.45
Rate for Payer: UnitedHealthcare Medicaid	$8,818.45

CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS

Facility

$5,139.64

Service Code	APR-DRG 1921
Min. Negotiated Rate	$5,139.64
Max. Negotiated Rate	$5,139.64
Rate for Payer: AlohaCare Medicaid	$5,139.64
Rate for Payer: Hawaii Medical Service Association ABD	$5,139.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,139.64
Rate for Payer: Kaiser Permanente Medicaid	$5,139.64
Rate for Payer: Ohana Health Plan Medicaid	$5,139.64
Rate for Payer: UnitedHealthcare Medicaid	$5,139.64

CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS

Facility

$13,694.45

Service Code	APR-DRG 1924
Min. Negotiated Rate	$13,694.45
Max. Negotiated Rate	$13,694.45
Rate for Payer: AlohaCare Medicaid	$13,694.45
Rate for Payer: Hawaii Medical Service Association ABD	$13,694.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,694.45
Rate for Payer: Kaiser Permanente Medicaid	$13,694.45
Rate for Payer: Ohana Health Plan Medicaid	$13,694.45
Rate for Payer: UnitedHealthcare Medicaid	$13,694.45

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC

Facility

$27,182.55

Service Code	MSDRG 306
Min. Negotiated Rate	$14,199.02
Max. Negotiated Rate	$27,182.55
Rate for Payer: AlohaCare Medicare	$20,726.13
Rate for Payer: Devoted Health Medicare	$22,798.74
Rate for Payer: Hawaii Medical Service Association Commercial	$14,199.02
Rate for Payer: Hawaii Medical Service Association Medicare	$20,726.13
Rate for Payer: Humana Medicare	$20,726.13
Rate for Payer: Kaiser Permanente Commercial	$27,182.55
Rate for Payer: Kaiser Permanente Medicare	$20,726.13
Rate for Payer: Ohana Health Plan Medicare	$20,726.13
Rate for Payer: UnitedHealthcare Medicare	$20,726.13

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC

Facility

$15,752.70

Service Code	MSDRG 307
Min. Negotiated Rate	$12,011.12
Max. Negotiated Rate	$15,752.70
Rate for Payer: AlohaCare Medicare	$12,011.12
Rate for Payer: Devoted Health Medicare	$13,212.23
Rate for Payer: Hawaii Medical Service Association Commercial	$13,114.21
Rate for Payer: Hawaii Medical Service Association Medicare	$12,011.12
Rate for Payer: Humana Medicare	$12,011.12
Rate for Payer: Kaiser Permanente Commercial	$15,752.70
Rate for Payer: Kaiser Permanente Medicare	$12,011.12
Rate for Payer: Ohana Health Plan Medicare	$12,011.12
Rate for Payer: UnitedHealthcare Medicare	$12,011.12

CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC

Facility

$162,770.46

Service Code	MSDRG 275
Min. Negotiated Rate	$93,784.49
Max. Negotiated Rate	$162,770.46
Rate for Payer: AlohaCare Medicare	$93,784.49
Rate for Payer: Devoted Health Medicare	$103,162.94
Rate for Payer: Hawaii Medical Service Association Commercial	$162,770.46
Rate for Payer: Hawaii Medical Service Association Medicare	$93,784.49
Rate for Payer: Humana Medicare	$93,784.49
Rate for Payer: Kaiser Permanente Commercial	$122,999.40
Rate for Payer: Kaiser Permanente Medicare	$93,784.49
Rate for Payer: Ohana Health Plan Medicare	$93,784.49
Rate for Payer: UnitedHealthcare Medicare	$93,784.49

CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR

Facility

$104,769.02

Service Code	MSDRG 276
Min. Negotiated Rate	$79,003.40
Max. Negotiated Rate	$104,769.02
Rate for Payer: AlohaCare Medicare	$79,003.40
Rate for Payer: Devoted Health Medicare	$86,903.74
Rate for Payer: Hawaii Medical Service Association Commercial	$104,769.02
Rate for Payer: Hawaii Medical Service Association Medicare	$79,003.40
Rate for Payer: Humana Medicare	$79,003.40
Rate for Payer: Kaiser Permanente Commercial	$103,613.85
Rate for Payer: Kaiser Permanente Medicare	$79,003.40
Rate for Payer: Ohana Health Plan Medicare	$79,003.40
Rate for Payer: UnitedHealthcare Medicare	$79,003.40

CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC

Facility

$104,769.02

Service Code	MSDRG 277
Min. Negotiated Rate	$60,746.04
Max. Negotiated Rate	$104,769.02
Rate for Payer: AlohaCare Medicare	$60,746.04
Rate for Payer: Devoted Health Medicare	$66,820.64
Rate for Payer: Hawaii Medical Service Association Commercial	$104,769.02
Rate for Payer: Hawaii Medical Service Association Medicare	$60,746.04
Rate for Payer: Humana Medicare	$60,746.04
Rate for Payer: Kaiser Permanente Commercial	$79,669.12
Rate for Payer: Kaiser Permanente Medicare	$60,746.04
Rate for Payer: Ohana Health Plan Medicare	$60,746.04
Rate for Payer: UnitedHealthcare Medicare	$60,746.04

Cardiac Envelope Absorb CMRM6122 [3642244]

Facility

$3,482.50

Service Code	HCPCS C1781
Hospital Charge Code	3642244
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.20
Max. Negotiated Rate	$3,378.03
Rate for Payer: Cash Price	$2,263.62
Rate for Payer: Hawaii Western Management Group Commercial	$2,437.75
Rate for Payer: Health Management Network Commercial	$2,960.12
Rate for Payer: MDX Hawaii PPO	$3,378.03
Rate for Payer: University Health Alliance Commercial	$1,950.20

Cardiac Envelope Absorb CMRM6122 [3642244]

Facility

$3,482.50

Service Code	HCPCS C1781
Hospital Charge Code	3642244
Hospital Revenue Code	278
Min. Negotiated Rate	$1,776.08
Max. Negotiated Rate	$3,378.03
Rate for Payer: Cash Price	$2,263.62
Rate for Payer: Hawaii Western Management Group Commercial	$2,437.75
Rate for Payer: Health Management Network Commercial	$2,960.12
Rate for Payer: Kaiser Permanente Commercial	$2,193.97
Rate for Payer: Kaiser Permanente Medicaid	$1,776.08
Rate for Payer: MDX Hawaii PPO	$3,378.03
Rate for Payer: University Health Alliance Commercial	$1,950.20

Cardiac Envelope Absorb CMRM6133 [3641195]

Facility

$4,980.50

Hospital Charge Code	3641195
Hospital Revenue Code	278
Min. Negotiated Rate	$2,540.05
Max. Negotiated Rate	$4,831.09
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,486.35
Rate for Payer: Health Management Network Commercial	$4,233.43
Rate for Payer: Kaiser Permanente Commercial	$3,137.72
Rate for Payer: Kaiser Permanente Medicaid	$2,540.05
Rate for Payer: MDX Hawaii PPO	$4,831.09
Rate for Payer: University Health Alliance Commercial	$2,789.08

Cardiac Envelope Absorb CMRM6133 [3641195]

Facility

$4,980.50

Hospital Charge Code	3641195
Hospital Revenue Code	278
Min. Negotiated Rate	$2,789.08
Max. Negotiated Rate	$4,831.09
Rate for Payer: Cash Price	$3,237.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,486.35
Rate for Payer: Health Management Network Commercial	$4,233.43
Rate for Payer: MDX Hawaii PPO	$4,831.09
Rate for Payer: University Health Alliance Commercial	$2,789.08

CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT

Facility

$6,078.28

Service Code	APR-DRG 1771
Min. Negotiated Rate	$6,078.28
Max. Negotiated Rate	$6,078.28
Rate for Payer: AlohaCare Medicaid	$6,078.28
Rate for Payer: Hawaii Medical Service Association ABD	$6,078.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,078.28
Rate for Payer: Kaiser Permanente Medicaid	$6,078.28
Rate for Payer: Ohana Health Plan Medicaid	$6,078.28
Rate for Payer: UnitedHealthcare Medicaid	$6,078.28

CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT

Facility

$14,600.62

Service Code	APR-DRG 1774
Min. Negotiated Rate	$14,600.62
Max. Negotiated Rate	$14,600.62
Rate for Payer: AlohaCare Medicaid	$14,600.62
Rate for Payer: Hawaii Medical Service Association ABD	$14,600.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14,600.62
Rate for Payer: Kaiser Permanente Medicaid	$14,600.62
Rate for Payer: Ohana Health Plan Medicaid	$14,600.62
Rate for Payer: UnitedHealthcare Medicaid	$14,600.62

CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT

Facility

$8,769.41

Service Code	APR-DRG 1772
Min. Negotiated Rate	$8,769.41
Max. Negotiated Rate	$8,769.41
Rate for Payer: AlohaCare Medicaid	$8,769.41
Rate for Payer: Hawaii Medical Service Association ABD	$8,769.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,769.41
Rate for Payer: Kaiser Permanente Medicaid	$8,769.41
Rate for Payer: Ohana Health Plan Medicaid	$8,769.41
Rate for Payer: UnitedHealthcare Medicaid	$8,769.41

CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT

Facility

$10,749.87

Service Code	APR-DRG 1773
Min. Negotiated Rate	$10,749.87
Max. Negotiated Rate	$10,749.87
Rate for Payer: AlohaCare Medicaid	$10,749.87
Rate for Payer: Hawaii Medical Service Association ABD	$10,749.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,749.87
Rate for Payer: Kaiser Permanente Medicaid	$10,749.87
Rate for Payer: Ohana Health Plan Medicaid	$10,749.87
Rate for Payer: UnitedHealthcare Medicaid	$10,749.87

CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC

Facility

$54,201.22

Service Code	MSDRG 258
Min. Negotiated Rate	$23,480.22
Max. Negotiated Rate	$54,201.22
Rate for Payer: AlohaCare Medicare	$41,327.31
Rate for Payer: Devoted Health Medicare	$45,460.04
Rate for Payer: Hawaii Medical Service Association Commercial	$23,480.22
Rate for Payer: Hawaii Medical Service Association Medicare	$41,327.31
Rate for Payer: Humana Medicare	$41,327.31
Rate for Payer: Kaiser Permanente Commercial	$54,201.22
Rate for Payer: Kaiser Permanente Medicare	$41,327.31
Rate for Payer: Ohana Health Plan Medicare	$41,327.31
Rate for Payer: UnitedHealthcare Medicare	$41,327.31

CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC

Facility

$34,881.22

Service Code	MSDRG 259
Min. Negotiated Rate	$23,480.22
Max. Negotiated Rate	$34,881.22
Rate for Payer: AlohaCare Medicare	$26,596.21
Rate for Payer: Devoted Health Medicare	$29,255.83
Rate for Payer: Hawaii Medical Service Association Commercial	$23,480.22
Rate for Payer: Hawaii Medical Service Association Medicare	$26,596.21
Rate for Payer: Humana Medicare	$26,596.21
Rate for Payer: Kaiser Permanente Commercial	$34,881.22
Rate for Payer: Kaiser Permanente Medicare	$26,596.21
Rate for Payer: Ohana Health Plan Medicare	$26,596.21
Rate for Payer: UnitedHealthcare Medicare	$26,596.21

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC

Facility

$32,611.12

Service Code	MSDRG 261
Min. Negotiated Rate	$24,865.31
Max. Negotiated Rate	$32,611.12
Rate for Payer: AlohaCare Medicare	$24,865.31
Rate for Payer: Devoted Health Medicare	$27,351.84
Rate for Payer: Hawaii Medical Service Association Commercial	$31,700.71
Rate for Payer: Hawaii Medical Service Association Medicare	$24,865.31
Rate for Payer: Humana Medicare	$24,865.31
Rate for Payer: Kaiser Permanente Commercial	$32,611.12
Rate for Payer: Kaiser Permanente Medicare	$24,865.31
Rate for Payer: Ohana Health Plan Medicare	$24,865.31
Rate for Payer: UnitedHealthcare Medicare	$24,865.31

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC

Facility

$56,110.80

Service Code	MSDRG 260
Min. Negotiated Rate	$31,700.71
Max. Negotiated Rate	$56,110.80
Rate for Payer: AlohaCare Medicare	$42,783.33
Rate for Payer: Devoted Health Medicare	$47,061.66
Rate for Payer: Hawaii Medical Service Association Commercial	$31,700.71
Rate for Payer: Hawaii Medical Service Association Medicare	$42,783.33
Rate for Payer: Humana Medicare	$42,783.33
Rate for Payer: Kaiser Permanente Commercial	$56,110.80
Rate for Payer: Kaiser Permanente Medicare	$42,783.33
Rate for Payer: Ohana Health Plan Medicare	$42,783.33
Rate for Payer: UnitedHealthcare Medicare	$42,783.33

Know your out-of-pocket cost for care.

All Charges