Hawaii / Kona Community Hospital
CMS certification 120019 · Kealakekua, HI · 2 entries in CMS's price-transparency list
Kona Community Hospital: charges and Medicare payments
Kona Community Hospital reported 161 Medicare inpatient stays across 8 DRGs in 2024. Across them it charged 2.37 times what it was paid — among the lower ratios in Hawaii, number 8 of 11 hospitals with at least 100 stays (state median 2.84×, national 4.15×). Its most frequent stay was DRG 871, Septicemia or Severe Sepsis without MV >96 Hours with MCC: 45 stays at an average charge of $78,383, 13% below the national average. It also billed 205 outpatient services, charging 4.77 times what Medicare paid.
- 1Medicare inpatient stays 161
- 2Charge ÷ paid, inpatient 2.37×
- 3Rank in HI (highest ratio = 1) 8 of 11
- 4CMS price-transparency actions 2
Inpatient stays
For the 8 DRGs that can be compared with the national average, Kona Community Hospital charged more than the national average in 1 (13%). Payments follow Medicare's rates, so they usually vary far less than charges.
| DRG | Stays | Avg charge | vs US | Avg paid |
|---|---|---|---|---|
| 871 Septicemia or Severe Sepsis without MV >96 Hours with MCC | 45 | $78,383 | -13% | $34,520 |
| 177 Respiratory Infections and Inflammations with MCC | 27 | $66,058 | -6% | $26,562 |
| 291 Heart Failure and Shock with MCC | 24 | $45,526 | -19% | $20,323 |
| 193 Simple Pneumonia and Pleurisy with MCC | 19 | $62,026 | +4% | $22,716 |
| 392 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 13 | $22,107 | -45% | $12,369 |
| 066 Intracranial Hemorrhage or Cerebral Infarction without... | 11 | $39,106 | -8% | $12,854 |
| 641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 11 | $25,400 | -31% | $12,358 |
| 872 Septicemia or Severe Sepsis without MV >96 Hours without MCC | 11 | $45,970 | -6% | $18,268 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Comprehensive Observation Services | 46 | $16,018 | $3,268 |
| Level 5 Musculoskeletal Procedures | 39 | $60,684 | $15,432 |
| Level 3 Vascular Procedures | 17 | $17,456 | $3,742 |
| Level 1 Laparoscopy and Related Services | 17 | $28,550 | $7,107 |
| Level 2 Musculoskeletal Procedures | 16 | $9,863 | $1,980 |
| Level 2 Upper GI Procedures | 16 | $8,603 | $2,344 |
| Level 6 Musculoskeletal Procedures | 14 | $90,600 | $22,895 |
| Level 5 Urology and Related Services | 14 | $18,301 | $6,374 |
| Level 4 Musculoskeletal Procedures | 13 | $46,764 | $8,809 |
| Level 4 Urology and Related Services | 13 | $14,252 | $4,031 |
Against the Hawaii average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Kona Community Hospital charged $78,383 on average, 13% more than the Hawaii average of $69,229, and was paid $34,520 against a state average of $23,514. For Respiratory Infections and Inflammations with MCC (DRG 177), Kona Community Hospital charged $66,058 on average, 7% more than the Hawaii average of $61,878, and was paid $26,562 against a state average of $19,768. For Heart Failure and Shock with MCC (DRG 291), Kona Community Hospital charged $45,526 on average, 12% less than the Hawaii average of $51,774, and was paid $20,323 against a state average of $16,264. For Simple Pneumonia and Pleurisy with MCC (DRG 193), Kona Community Hospital charged $62,026 on average, 23% more than the Hawaii average of $50,424, and was paid $22,716 against a state average of $16,146. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $16,018 was 13% below the state average of $18,402. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $60,684 was 12% above the state average of $54,220. For Level 3 Vascular Procedures (outpatient APC 5183), its average charge of $17,456 was 12% above the state average of $15,603. For Level 1 Laparoscopy and Related Services (outpatient APC 5361), its average charge of $28,550 was 0% below the state average of $28,603.
Price-transparency record
CMS's enforcement list records these actions for a hospital named Kona Community Hospital in Kealakekua, HI, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:
- Warning Notice — 2026-06-08 (CMS case 7968)
- Closure Notice — 2026-07-13 (CMS case 7968)
A warning notice or corrective-action request is not a finding of wrongdoing; "Met Requirements" and closure notices record that CMS's review ended. Matched to this hospital by exact name, city and state.
Charges are the hospital's list prices averaged over its 2024 Medicare cases; payments are what those cases actually brought in. Neither is what you will pay. For a planned procedure, ask the hospital for its price estimate or, if you are uninsured or self-paying, a good-faith estimate.
Sources: CMS Medicare Inpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Medicare Outpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Hospital Price Transparency Enforcement Activities and Outcomes, July 2026. Checked 2026-10-24. Methodology.