Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Handpiece Abc Bend-A-Beam 9" 134009 [3643506]

Facility

$473.27

Hospital Charge Code	3643506
Hospital Revenue Code	272
Min. Negotiated Rate	$402.28
Max. Negotiated Rate	$459.07
Rate for Payer: Cash Price	$307.63
Rate for Payer: Health Management Network Commercial	$402.28
Rate for Payer: MDX Hawaii PPO	$459.07

HAND PROCEDURES FOR INJURIES

Facility

$30,401.40

Service Code	MSDRG 906
Min. Negotiated Rate	$22,540.04
Max. Negotiated Rate	$30,401.40
Rate for Payer: AlohaCare Medicare	$25,835.98
Rate for Payer: Devoted Health Medicare	$28,419.58
Rate for Payer: Hawaii Medical Service Association Commercial	$22,540.04
Rate for Payer: Hawaii Medical Service Association Medicare	$25,835.98
Rate for Payer: Humana Medicare	$25,835.98
Rate for Payer: Kaiser Permanente Commercial	$30,401.40
Rate for Payer: Kaiser Permanente Medicare	$25,835.98
Rate for Payer: Ohana Health Plan Medicare	$25,835.98
Rate for Payer: UnitedHealthcare Medicare	$25,835.98

HAND & WRIST PROCEDURES

Facility

$15,574.29

Service Code	APR-DRG 3164
Min. Negotiated Rate	$15,574.29
Max. Negotiated Rate	$15,574.29
Rate for Payer: AlohaCare Medicaid	$15,574.29
Rate for Payer: Hawaii Medical Service Association ABD	$15,574.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15,574.29
Rate for Payer: Kaiser Permanente Medicaid	$15,574.29
Rate for Payer: Ohana Health Plan Medicaid	$15,574.29
Rate for Payer: UnitedHealthcare Medicaid	$15,574.29

HAND & WRIST PROCEDURES

Facility

$8,381.60

Service Code	APR-DRG 3163
Min. Negotiated Rate	$8,381.60
Max. Negotiated Rate	$8,381.60
Rate for Payer: AlohaCare Medicaid	$8,381.60
Rate for Payer: Hawaii Medical Service Association ABD	$8,381.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,381.60
Rate for Payer: Kaiser Permanente Medicaid	$8,381.60
Rate for Payer: Ohana Health Plan Medicaid	$8,381.60
Rate for Payer: UnitedHealthcare Medicaid	$8,381.60

HAND & WRIST PROCEDURES

Facility

$5,689.83

Service Code	APR-DRG 3162
Min. Negotiated Rate	$5,689.83
Max. Negotiated Rate	$5,689.83
Rate for Payer: AlohaCare Medicaid	$5,689.83
Rate for Payer: Hawaii Medical Service Association ABD	$5,689.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,689.83
Rate for Payer: Kaiser Permanente Medicaid	$5,689.83
Rate for Payer: Ohana Health Plan Medicaid	$5,689.83
Rate for Payer: UnitedHealthcare Medicaid	$5,689.83

HAND & WRIST PROCEDURES

Facility

$4,318.80

Service Code	APR-DRG 3161
Min. Negotiated Rate	$4,318.80
Max. Negotiated Rate	$4,318.80
Rate for Payer: AlohaCare Medicaid	$4,318.80
Rate for Payer: Hawaii Medical Service Association ABD	$4,318.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,318.80
Rate for Payer: Kaiser Permanente Medicaid	$4,318.80
Rate for Payer: Ohana Health Plan Medicaid	$4,318.80
Rate for Payer: UnitedHealthcare Medicaid	$4,318.80

HCHG 12 LEAD EKG

Facility

$226.00

Service Code	HCPCS 93000
Hospital Charge Code	H7300130
Hospital Revenue Code	730
Min. Negotiated Rate	$192.10
Max. Negotiated Rate	$219.22
Rate for Payer: Cash Price	$146.90
Rate for Payer: Health Management Network Commercial	$192.10
Rate for Payer: MDX Hawaii PPO	$219.22

HCHG 12 LEAD EKG

Facility

$226.00

Service Code	HCPCS 93000
Hospital Charge Code	H7300130
Hospital Revenue Code	730
Min. Negotiated Rate	$23.63
Max. Negotiated Rate	$219.22
Rate for Payer: Cash Price	$146.90
Rate for Payer: Cash Price	$146.90
Rate for Payer: Hawaii Western Management Group Commercial	$214.70
Rate for Payer: Health Management Network Commercial	$192.10
Rate for Payer: Kaiser Permanente Commercial	$142.38
Rate for Payer: Kaiser Permanente Medicaid	$115.26
Rate for Payer: MDX Hawaii PPO	$219.22
Rate for Payer: UnitedHealthcare Medicaid	$23.63
Rate for Payer: University Health Alliance Commercial	$164.73

HCHG 1 ADDL FROZEN SECT

Facility

$191.00

Service Code	HCPCS 88332
Hospital Charge Code	H3120102
Hospital Revenue Code	312
Min. Negotiated Rate	$6.29
Max. Negotiated Rate	$185.27
Rate for Payer: Cash Price	$124.15
Rate for Payer: Cash Price	$124.15
Rate for Payer: Hawaii Medical Service Association ABD	$6.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.19
Rate for Payer: Hawaii Western Management Group Commercial	$181.45
Rate for Payer: Health Management Network Commercial	$162.35
Rate for Payer: Kaiser Permanente Commercial	$120.33
Rate for Payer: Kaiser Permanente Medicaid	$97.41
Rate for Payer: MDX Hawaii PPO	$185.27
Rate for Payer: UnitedHealthcare Medicaid	$6.29
Rate for Payer: University Health Alliance Commercial	$76.37

HCHG 1 ADDL FROZEN SECT

Facility

$191.00

Service Code	HCPCS 88332
Hospital Charge Code	H3120102
Hospital Revenue Code	312
Min. Negotiated Rate	$162.35
Max. Negotiated Rate	$185.27
Rate for Payer: Cash Price	$124.15
Rate for Payer: Health Management Network Commercial	$162.35
Rate for Payer: MDX Hawaii PPO	$185.27

HCHG 2D ECHO COMPLETE M MODE F/U LTD

Facility

$791.00

Service Code	HCPCS 93308
Hospital Charge Code	H4800102
Hospital Revenue Code	480
Min. Negotiated Rate	$64.51
Max. Negotiated Rate	$767.27
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$514.15
Rate for Payer: Cash Price	$514.15
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$64.51
Rate for Payer: Hawaii Medical Service Association Commercial	$352.34
Rate for Payer: Hawaii Medical Service Association Medicare	$281.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$67.74
Rate for Payer: Hawaii Western Management Group Commercial	$751.45
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$498.33
Rate for Payer: Kaiser Permanente Medicaid	$403.41
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$767.27
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$64.51
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$576.56

HCHG 2D ECHO COMPLETE M MODE F/U LTD

Facility

$791.00

Service Code	HCPCS 93308
Hospital Charge Code	H4800102
Hospital Revenue Code	480
Min. Negotiated Rate	$672.35
Max. Negotiated Rate	$767.27
Rate for Payer: Cash Price	$514.15
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: MDX Hawaii PPO	$767.27

HCHG 2D TTE W OR W/O FOL W/CON,CO

Facility

$3,400.00

Service Code	HCPCS C8923
Hospital Charge Code	H4830106
Hospital Revenue Code	483
Min. Negotiated Rate	$592.55
Max. Negotiated Rate	$3,298.00
Rate for Payer: AlohaCare Medicaid	$926.08
Rate for Payer: AlohaCare Medicare	$926.08
Rate for Payer: Cash Price	$2,210.00
Rate for Payer: Cash Price	$2,210.00
Rate for Payer: Devoted Health Medicare	$1,018.69
Rate for Payer: Hawaii Medical Service Association Commercial	$1,157.60
Rate for Payer: Hawaii Medical Service Association Medicare	$926.08
Rate for Payer: Hawaii Western Management Group Commercial	$3,230.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Humana Medicare	$926.08
Rate for Payer: Kaiser Permanente Commercial	$2,142.00
Rate for Payer: Kaiser Permanente Medicaid	$1,734.00
Rate for Payer: Kaiser Permanente Medicare	$926.08
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: Ohana Health Plan Medicaid	$1,018.69
Rate for Payer: Ohana Health Plan Medicare	$926.08
Rate for Payer: UnitedHealthcare Medicaid	$592.55
Rate for Payer: UnitedHealthcare Medicare	$926.08
Rate for Payer: University Health Alliance Commercial	$2,478.26

HCHG 2D TTE W OR W/O FOL W/CON,CO

Facility

$3,400.00

Service Code	HCPCS C8923
Hospital Charge Code	H4830106
Hospital Revenue Code	483
Min. Negotiated Rate	$2,890.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: Cash Price	$2,210.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: MDX Hawaii PPO	$3,298.00

HCHG 3-D RADIOTHERAPY PLAN

Facility

$6,490.00

Service Code	HCPCS 77295
Hospital Charge Code	H3330249
Hospital Revenue Code	333
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$6,295.30
Rate for Payer: AlohaCare Medicaid	$1,635.14
Rate for Payer: AlohaCare Medicare	$1,635.14
Rate for Payer: Cash Price	$4,218.50
Rate for Payer: Cash Price	$4,218.50
Rate for Payer: Devoted Health Medicare	$1,798.65
Rate for Payer: Hawaii Medical Service Association ABD	$1,027.08
Rate for Payer: Hawaii Medical Service Association Commercial	$2,043.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,635.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,014.37
Rate for Payer: Hawaii Western Management Group Commercial	$1,635.14
Rate for Payer: Health Management Network Commercial	$5,516.50
Rate for Payer: Humana Medicare	$1,635.14
Rate for Payer: Kaiser Permanente Commercial	$4,088.70
Rate for Payer: Kaiser Permanente Medicaid	$3,309.90
Rate for Payer: Kaiser Permanente Medicare	$1,635.14
Rate for Payer: MDX Hawaii PPO	$6,295.30
Rate for Payer: Ohana Health Plan Medicaid	$1,798.65
Rate for Payer: Ohana Health Plan Medicare	$1,635.14
Rate for Payer: UnitedHealthcare Medicaid	$1.00
Rate for Payer: UnitedHealthcare Medicare	$1,635.14
Rate for Payer: University Health Alliance Commercial	$1,847.52

HCHG 3-D RADIOTHERAPY PLAN

Facility

$6,490.00

Service Code	HCPCS 77295
Hospital Charge Code	H3330249
Hospital Revenue Code	333
Min. Negotiated Rate	$5,516.50
Max. Negotiated Rate	$6,295.30
Rate for Payer: Cash Price	$4,218.50
Rate for Payer: Health Management Network Commercial	$5,516.50
Rate for Payer: MDX Hawaii PPO	$6,295.30

HCHG 3D RENDERING W/POSTPROCESS INDEPENDENT WORKSTATION

Facility

$528.00

Service Code	HCPCS 76377
Hospital Charge Code	H3500209
Hospital Revenue Code	350
Min. Negotiated Rate	$448.80
Max. Negotiated Rate	$512.16
Rate for Payer: Cash Price	$343.20
Rate for Payer: Health Management Network Commercial	$448.80
Rate for Payer: MDX Hawaii PPO	$512.16

HCHG 3D RENDERING W/POSTPROCESS INDEPENDENT WORKSTATION

Facility

$528.00

Service Code	HCPCS 76377
Hospital Charge Code	H3500209
Hospital Revenue Code	350
Min. Negotiated Rate	$38.91
Max. Negotiated Rate	$512.16
Rate for Payer: Cash Price	$343.20
Rate for Payer: Cash Price	$343.20
Rate for Payer: Hawaii Medical Service Association ABD	$102.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$38.91
Rate for Payer: Hawaii Western Management Group Commercial	$501.60
Rate for Payer: Health Management Network Commercial	$448.80
Rate for Payer: Kaiser Permanente Commercial	$332.64
Rate for Payer: Kaiser Permanente Medicaid	$269.28
Rate for Payer: MDX Hawaii PPO	$512.16
Rate for Payer: UnitedHealthcare Medicaid	$102.78
Rate for Payer: University Health Alliance Commercial	$272.82

HCHG 3D RENDER W/O POSTPROCESS INDEPENDENT WORKSTATION

Facility

$225.00

Service Code	HCPCS 76376
Hospital Charge Code	H6100215
Hospital Revenue Code	610
Min. Negotiated Rate	$40.37
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Hawaii Medical Service Association ABD	$98.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$40.37
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$141.75
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: UnitedHealthcare Medicaid	$98.13
Rate for Payer: University Health Alliance Commercial	$214.08

HCHG 3D RENDER W/O POSTPROCESS INDEPENDENT WORKSTATION

Facility

$225.00

Service Code	HCPCS 76376
Hospital Charge Code	H6100215
Hospital Revenue Code	610
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: MDX Hawaii PPO	$218.25

HCHG 5-HIAA 24 HR URINE

Facility

$159.00

Service Code	HCPCS 83497
Hospital Charge Code	H3010112
Hospital Revenue Code	301
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$154.23
Rate for Payer: AlohaCare Medicaid	$12.90
Rate for Payer: AlohaCare Medicare	$12.90
Rate for Payer: Cash Price	$103.35
Rate for Payer: Cash Price	$103.35
Rate for Payer: Devoted Health Medicare	$14.19
Rate for Payer: Hawaii Medical Service Association ABD	$17.82
Rate for Payer: Hawaii Medical Service Association Commercial	$16.12
Rate for Payer: Hawaii Medical Service Association Medicare	$12.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.71
Rate for Payer: Hawaii Western Management Group Commercial	$12.90
Rate for Payer: Health Management Network Commercial	$135.15
Rate for Payer: Humana Medicare	$12.90
Rate for Payer: Kaiser Permanente Commercial	$100.17
Rate for Payer: Kaiser Permanente Medicaid	$81.09
Rate for Payer: Kaiser Permanente Medicare	$12.90
Rate for Payer: MDX Hawaii PPO	$154.23
Rate for Payer: Ohana Health Plan Medicaid	$14.19
Rate for Payer: Ohana Health Plan Medicare	$12.90
Rate for Payer: UnitedHealthcare Medicaid	$17.82
Rate for Payer: UnitedHealthcare Medicare	$12.90
Rate for Payer: University Health Alliance Commercial	$33.32

HCHG 5-HIAA 24 HR URINE

Facility

$159.00

Service Code	HCPCS 83497
Hospital Charge Code	H3010112
Hospital Revenue Code	301
Min. Negotiated Rate	$135.15
Max. Negotiated Rate	$154.23
Rate for Payer: Cash Price	$103.35
Rate for Payer: Health Management Network Commercial	$135.15
Rate for Payer: MDX Hawaii PPO	$154.23

HCHG AB COXIELLA BRUNETII EA

Facility

$149.00

Service Code	HCPCS 86638
Hospital Charge Code	H3020106
Hospital Revenue Code	302
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$144.53
Rate for Payer: AlohaCare Medicaid	$12.12
Rate for Payer: AlohaCare Medicare	$12.12
Rate for Payer: Cash Price	$96.85
Rate for Payer: Cash Price	$96.85
Rate for Payer: Devoted Health Medicare	$13.33
Rate for Payer: Hawaii Medical Service Association ABD	$10.16
Rate for Payer: Hawaii Medical Service Association Commercial	$15.15
Rate for Payer: Hawaii Medical Service Association Medicare	$12.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.74
Rate for Payer: Hawaii Western Management Group Commercial	$12.12
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Humana Medicare	$12.12
Rate for Payer: Kaiser Permanente Commercial	$93.87
Rate for Payer: Kaiser Permanente Medicaid	$75.99
Rate for Payer: Kaiser Permanente Medicare	$12.12
Rate for Payer: MDX Hawaii PPO	$144.53
Rate for Payer: Ohana Health Plan Medicaid	$13.33
Rate for Payer: Ohana Health Plan Medicare	$12.12
Rate for Payer: UnitedHealthcare Medicaid	$10.16
Rate for Payer: UnitedHealthcare Medicare	$12.12
Rate for Payer: University Health Alliance Commercial	$31.34

HCHG AB COXIELLA BRUNETII EA

Facility

$149.00

Service Code	HCPCS 86638
Hospital Charge Code	H3020104
Hospital Revenue Code	302
Min. Negotiated Rate	$126.65
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$96.85
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: MDX Hawaii PPO	$144.53

HCHG AB COXIELLA BRUNETII EA

Facility

$149.00

Service Code	HCPCS 86638
Hospital Charge Code	H3020104
Hospital Revenue Code	302
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$144.53
Rate for Payer: AlohaCare Medicaid	$12.12
Rate for Payer: AlohaCare Medicare	$12.12
Rate for Payer: Cash Price	$96.85
Rate for Payer: Cash Price	$96.85
Rate for Payer: Devoted Health Medicare	$13.33
Rate for Payer: Hawaii Medical Service Association ABD	$10.16
Rate for Payer: Hawaii Medical Service Association Commercial	$15.15
Rate for Payer: Hawaii Medical Service Association Medicare	$12.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.74
Rate for Payer: Hawaii Western Management Group Commercial	$12.12
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Humana Medicare	$12.12
Rate for Payer: Kaiser Permanente Commercial	$93.87
Rate for Payer: Kaiser Permanente Medicaid	$75.99
Rate for Payer: Kaiser Permanente Medicare	$12.12
Rate for Payer: MDX Hawaii PPO	$144.53
Rate for Payer: Ohana Health Plan Medicaid	$13.33
Rate for Payer: Ohana Health Plan Medicare	$12.12
Rate for Payer: UnitedHealthcare Medicaid	$10.16
Rate for Payer: UnitedHealthcare Medicare	$12.12
Rate for Payer: University Health Alliance Commercial	$31.34

Know your out-of-pocket cost for care.

All Charges