Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG ABD PARACENTESIS DX/THER W/IMG GUID

Facility

$3,899.00

Service Code	HCPCS 49083
Hospital Charge Code	H3600739
Hospital Revenue Code	361
Min. Negotiated Rate	$3,314.15
Max. Negotiated Rate	$3,782.03
Rate for Payer: Cash Price	$2,534.35
Rate for Payer: Health Management Network Commercial	$3,314.15
Rate for Payer: MDX Hawaii PPO	$3,782.03

HCHG ABD PARACENTESIS DX/THER W/IMG GUID

Facility

$3,899.00

Service Code	HCPCS 49083
Hospital Charge Code	H4501046
Hospital Revenue Code	450
Min. Negotiated Rate	$3,314.15
Max. Negotiated Rate	$3,782.03
Rate for Payer: Cash Price	$2,534.35
Rate for Payer: Health Management Network Commercial	$3,314.15
Rate for Payer: MDX Hawaii PPO	$3,782.03

HCHG ABD PARACENTESIS DX/THER W/IMG GUID

Facility

$3,899.00

Service Code	HCPCS 49083
Hospital Charge Code	H4501046
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$3,782.03
Rate for Payer: AlohaCare Medicaid	$1,071.46
Rate for Payer: AlohaCare Medicare	$1,071.46
Rate for Payer: Cash Price	$2,534.35
Rate for Payer: Cash Price	$2,534.35
Rate for Payer: Cash Price	$2,534.35
Rate for Payer: Devoted Health Medicare	$1,178.61
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,071.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,704.05
Rate for Payer: Health Management Network Commercial	$3,314.15
Rate for Payer: Humana Medicare	$1,071.46
Rate for Payer: Kaiser Permanente Commercial	$2,456.37
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,071.46
Rate for Payer: MDX Hawaii PPO	$3,782.03
Rate for Payer: Ohana Health Plan Medicaid	$1,178.61
Rate for Payer: Ohana Health Plan Medicare	$1,071.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,071.46
Rate for Payer: University Health Alliance Commercial	$2,841.98

HCHG ABD PARACENTESIS DX/THER W/IMG GUID

Facility

$3,899.00

Service Code	HCPCS 49083
Hospital Charge Code	H3600739
Hospital Revenue Code	361
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$3,782.03
Rate for Payer: AlohaCare Medicaid	$1,071.46
Rate for Payer: AlohaCare Medicare	$1,071.46
Rate for Payer: Cash Price	$2,534.35
Rate for Payer: Cash Price	$2,534.35
Rate for Payer: Cash Price	$2,534.35
Rate for Payer: Devoted Health Medicare	$1,178.61
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,071.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$3,314.15
Rate for Payer: Humana Medicare	$1,071.46
Rate for Payer: Kaiser Permanente Commercial	$2,456.37
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,071.46
Rate for Payer: MDX Hawaii PPO	$3,782.03
Rate for Payer: Ohana Health Plan Medicaid	$1,178.61
Rate for Payer: Ohana Health Plan Medicare	$1,071.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,071.46
Rate for Payer: University Health Alliance Commercial	$2,841.98

HCHG AB ID ABSORPTION

Facility

$436.00

Service Code	HCPCS 86978
Hospital Charge Code	H3020110
Hospital Revenue Code	302
Min. Negotiated Rate	$31.69
Max. Negotiated Rate	$422.92
Rate for Payer: AlohaCare Medicaid	$69.69
Rate for Payer: AlohaCare Medicare	$69.69
Rate for Payer: Cash Price	$283.40
Rate for Payer: Cash Price	$283.40
Rate for Payer: Devoted Health Medicare	$76.66
Rate for Payer: Hawaii Medical Service Association ABD	$31.69
Rate for Payer: Hawaii Medical Service Association Commercial	$87.11
Rate for Payer: Hawaii Medical Service Association Medicare	$69.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$31.69
Rate for Payer: Hawaii Western Management Group Commercial	$69.69
Rate for Payer: Health Management Network Commercial	$370.60
Rate for Payer: Humana Medicare	$69.69
Rate for Payer: Kaiser Permanente Commercial	$274.68
Rate for Payer: Kaiser Permanente Medicaid	$222.36
Rate for Payer: Kaiser Permanente Medicare	$69.69
Rate for Payer: MDX Hawaii PPO	$422.92
Rate for Payer: Ohana Health Plan Medicaid	$76.66
Rate for Payer: Ohana Health Plan Medicare	$69.69
Rate for Payer: UnitedHealthcare Medicaid	$44.55
Rate for Payer: UnitedHealthcare Medicare	$69.69
Rate for Payer: University Health Alliance Commercial	$317.80

HCHG AB ID ABSORPTION

Facility

$436.00

Service Code	HCPCS 86978
Hospital Charge Code	H3020110
Hospital Revenue Code	302
Min. Negotiated Rate	$370.60
Max. Negotiated Rate	$422.92
Rate for Payer: Cash Price	$283.40
Rate for Payer: Health Management Network Commercial	$370.60
Rate for Payer: MDX Hawaii PPO	$422.92

HCHG AB ID ADDL 1 PANEL

Facility

$703.00

Service Code	HCPCS 86870
Hospital Charge Code	H3000104
Hospital Revenue Code	302
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$681.91
Rate for Payer: AlohaCare Medicaid	$423.45
Rate for Payer: AlohaCare Medicare	$423.45
Rate for Payer: Cash Price	$456.95
Rate for Payer: Cash Price	$456.95
Rate for Payer: Devoted Health Medicare	$465.80
Rate for Payer: Hawaii Medical Service Association ABD	$55.70
Rate for Payer: Hawaii Medical Service Association Commercial	$529.31
Rate for Payer: Hawaii Medical Service Association Medicare	$423.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.00
Rate for Payer: Hawaii Western Management Group Commercial	$423.45
Rate for Payer: Health Management Network Commercial	$597.55
Rate for Payer: Humana Medicare	$423.45
Rate for Payer: Kaiser Permanente Commercial	$442.89
Rate for Payer: Kaiser Permanente Medicaid	$358.53
Rate for Payer: Kaiser Permanente Medicare	$423.45
Rate for Payer: MDX Hawaii PPO	$681.91
Rate for Payer: Ohana Health Plan Medicaid	$465.80
Rate for Payer: Ohana Health Plan Medicare	$423.45
Rate for Payer: UnitedHealthcare Medicaid	$55.70
Rate for Payer: UnitedHealthcare Medicare	$423.45
Rate for Payer: University Health Alliance Commercial	$512.42

HCHG AB ID ADDL 1 PANEL

Facility

$703.00

Service Code	HCPCS 86870
Hospital Charge Code	H3000104
Hospital Revenue Code	302
Min. Negotiated Rate	$597.55
Max. Negotiated Rate	$681.91
Rate for Payer: Cash Price	$456.95
Rate for Payer: Health Management Network Commercial	$597.55
Rate for Payer: MDX Hawaii PPO	$681.91

HCHG AB ID ADDL PANEL I

Facility

$703.00

Service Code	HCPCS 86870
Hospital Charge Code	H3000106
Hospital Revenue Code	302
Min. Negotiated Rate	$597.55
Max. Negotiated Rate	$681.91
Rate for Payer: Cash Price	$456.95
Rate for Payer: Health Management Network Commercial	$597.55
Rate for Payer: MDX Hawaii PPO	$681.91

HCHG AB ID ADDL PANEL I

Facility

$703.00

Service Code	HCPCS 86870
Hospital Charge Code	H3000106
Hospital Revenue Code	302
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$681.91
Rate for Payer: AlohaCare Medicaid	$423.45
Rate for Payer: AlohaCare Medicare	$423.45
Rate for Payer: Cash Price	$456.95
Rate for Payer: Cash Price	$456.95
Rate for Payer: Devoted Health Medicare	$465.80
Rate for Payer: Hawaii Medical Service Association ABD	$55.70
Rate for Payer: Hawaii Medical Service Association Commercial	$529.31
Rate for Payer: Hawaii Medical Service Association Medicare	$423.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.00
Rate for Payer: Hawaii Western Management Group Commercial	$423.45
Rate for Payer: Health Management Network Commercial	$597.55
Rate for Payer: Humana Medicare	$423.45
Rate for Payer: Kaiser Permanente Commercial	$442.89
Rate for Payer: Kaiser Permanente Medicaid	$358.53
Rate for Payer: Kaiser Permanente Medicare	$423.45
Rate for Payer: MDX Hawaii PPO	$681.91
Rate for Payer: Ohana Health Plan Medicaid	$465.80
Rate for Payer: Ohana Health Plan Medicare	$423.45
Rate for Payer: UnitedHealthcare Medicaid	$55.70
Rate for Payer: UnitedHealthcare Medicare	$423.45
Rate for Payer: University Health Alliance Commercial	$512.42

HCHG AB ID ADDL PANEL II

Facility

$703.00

Service Code	HCPCS 86870
Hospital Charge Code	H3000110
Hospital Revenue Code	302
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$681.91
Rate for Payer: AlohaCare Medicaid	$423.45
Rate for Payer: AlohaCare Medicare	$423.45
Rate for Payer: Cash Price	$456.95
Rate for Payer: Cash Price	$456.95
Rate for Payer: Devoted Health Medicare	$465.80
Rate for Payer: Hawaii Medical Service Association ABD	$55.70
Rate for Payer: Hawaii Medical Service Association Commercial	$529.31
Rate for Payer: Hawaii Medical Service Association Medicare	$423.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.00
Rate for Payer: Hawaii Western Management Group Commercial	$423.45
Rate for Payer: Health Management Network Commercial	$597.55
Rate for Payer: Humana Medicare	$423.45
Rate for Payer: Kaiser Permanente Commercial	$442.89
Rate for Payer: Kaiser Permanente Medicaid	$358.53
Rate for Payer: Kaiser Permanente Medicare	$423.45
Rate for Payer: MDX Hawaii PPO	$681.91
Rate for Payer: Ohana Health Plan Medicaid	$465.80
Rate for Payer: Ohana Health Plan Medicare	$423.45
Rate for Payer: UnitedHealthcare Medicaid	$55.70
Rate for Payer: UnitedHealthcare Medicare	$423.45
Rate for Payer: University Health Alliance Commercial	$512.42

HCHG AB ID ADDL PANEL II

Facility

$703.00

Service Code	HCPCS 86870
Hospital Charge Code	H3000110
Hospital Revenue Code	302
Min. Negotiated Rate	$597.55
Max. Negotiated Rate	$681.91
Rate for Payer: Cash Price	$456.95
Rate for Payer: Health Management Network Commercial	$597.55
Rate for Payer: MDX Hawaii PPO	$681.91

HCHG AB ID ELUTION

Facility

$356.00

Service Code	HCPCS 86860
Hospital Charge Code	H3900102
Hospital Revenue Code	300
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$345.32
Rate for Payer: AlohaCare Medicaid	$201.27
Rate for Payer: AlohaCare Medicare	$201.27
Rate for Payer: Cash Price	$231.40
Rate for Payer: Cash Price	$231.40
Rate for Payer: Devoted Health Medicare	$221.40
Rate for Payer: Hawaii Medical Service Association ABD	$16.20
Rate for Payer: Hawaii Medical Service Association Commercial	$251.59
Rate for Payer: Hawaii Medical Service Association Medicare	$201.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$49.52
Rate for Payer: Hawaii Western Management Group Commercial	$201.27
Rate for Payer: Health Management Network Commercial	$302.60
Rate for Payer: Humana Medicare	$201.27
Rate for Payer: Kaiser Permanente Commercial	$224.28
Rate for Payer: Kaiser Permanente Medicaid	$181.56
Rate for Payer: Kaiser Permanente Medicare	$201.27
Rate for Payer: MDX Hawaii PPO	$345.32
Rate for Payer: Ohana Health Plan Medicaid	$221.40
Rate for Payer: Ohana Health Plan Medicare	$201.27
Rate for Payer: UnitedHealthcare Medicaid	$16.20
Rate for Payer: UnitedHealthcare Medicare	$201.27
Rate for Payer: University Health Alliance Commercial	$259.49

HCHG AB ID ELUTION

Facility

$356.00

Service Code	HCPCS 86860
Hospital Charge Code	H3900102
Hospital Revenue Code	300
Min. Negotiated Rate	$302.60
Max. Negotiated Rate	$345.32
Rate for Payer: Cash Price	$231.40
Rate for Payer: Health Management Network Commercial	$302.60
Rate for Payer: MDX Hawaii PPO	$345.32

HCHG AB IDENTIFICATION

Facility

$703.00

Service Code	HCPCS 86870
Hospital Charge Code	H3900104
Hospital Revenue Code	302
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$681.91
Rate for Payer: AlohaCare Medicaid	$423.45
Rate for Payer: AlohaCare Medicare	$423.45
Rate for Payer: Cash Price	$456.95
Rate for Payer: Cash Price	$456.95
Rate for Payer: Devoted Health Medicare	$465.80
Rate for Payer: Hawaii Medical Service Association ABD	$55.70
Rate for Payer: Hawaii Medical Service Association Commercial	$529.31
Rate for Payer: Hawaii Medical Service Association Medicare	$423.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.00
Rate for Payer: Hawaii Western Management Group Commercial	$423.45
Rate for Payer: Health Management Network Commercial	$597.55
Rate for Payer: Humana Medicare	$423.45
Rate for Payer: Kaiser Permanente Commercial	$442.89
Rate for Payer: Kaiser Permanente Medicaid	$358.53
Rate for Payer: Kaiser Permanente Medicare	$423.45
Rate for Payer: MDX Hawaii PPO	$681.91
Rate for Payer: Ohana Health Plan Medicaid	$465.80
Rate for Payer: Ohana Health Plan Medicare	$423.45
Rate for Payer: UnitedHealthcare Medicaid	$55.70
Rate for Payer: UnitedHealthcare Medicare	$423.45
Rate for Payer: University Health Alliance Commercial	$512.42

HCHG AB IDENTIFICATION

Facility

$703.00

Service Code	HCPCS 86870
Hospital Charge Code	H3900104
Hospital Revenue Code	302
Min. Negotiated Rate	$597.55
Max. Negotiated Rate	$681.91
Rate for Payer: Cash Price	$456.95
Rate for Payer: Health Management Network Commercial	$597.55
Rate for Payer: MDX Hawaii PPO	$681.91

HCHG AB INFLUENZA VIR RICKETTSIA EA

Facility

$238.00

Service Code	HCPCS 86757
Hospital Charge Code	H3020116
Hospital Revenue Code	302
Min. Negotiated Rate	$202.30
Max. Negotiated Rate	$230.86
Rate for Payer: Cash Price	$154.70
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: MDX Hawaii PPO	$230.86

HCHG AB INFLUENZA VIR RICKETTSIA EA

Facility

$238.00

Service Code	HCPCS 86757
Hospital Charge Code	H3020116
Hospital Revenue Code	302
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$230.86
Rate for Payer: AlohaCare Medicaid	$19.35
Rate for Payer: AlohaCare Medicare	$19.35
Rate for Payer: Cash Price	$154.70
Rate for Payer: Cash Price	$154.70
Rate for Payer: Devoted Health Medicare	$21.29
Rate for Payer: Hawaii Medical Service Association ABD	$26.75
Rate for Payer: Hawaii Medical Service Association Commercial	$24.19
Rate for Payer: Hawaii Medical Service Association Medicare	$19.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.09
Rate for Payer: Hawaii Western Management Group Commercial	$19.35
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: Humana Medicare	$19.35
Rate for Payer: Kaiser Permanente Commercial	$149.94
Rate for Payer: Kaiser Permanente Medicaid	$121.38
Rate for Payer: Kaiser Permanente Medicare	$19.35
Rate for Payer: MDX Hawaii PPO	$230.86
Rate for Payer: Ohana Health Plan Medicaid	$21.29
Rate for Payer: Ohana Health Plan Medicare	$19.35
Rate for Payer: UnitedHealthcare Medicaid	$26.75
Rate for Payer: UnitedHealthcare Medicare	$19.35
Rate for Payer: University Health Alliance Commercial	$50.04

HCHG ABSOLUTE CD4

Facility

$189.00

Service Code	HCPCS 86361
Hospital Charge Code	H3110118
Hospital Revenue Code	302
Min. Negotiated Rate	$160.65
Max. Negotiated Rate	$183.33
Rate for Payer: Cash Price	$122.85
Rate for Payer: Health Management Network Commercial	$160.65
Rate for Payer: MDX Hawaii PPO	$183.33

HCHG ABSOLUTE CD4

Facility

$189.00

Service Code	HCPCS 86361
Hospital Charge Code	H3110118
Hospital Revenue Code	302
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$183.33
Rate for Payer: AlohaCare Medicaid	$26.78
Rate for Payer: AlohaCare Medicare	$26.78
Rate for Payer: Cash Price	$122.85
Rate for Payer: Cash Price	$122.85
Rate for Payer: Devoted Health Medicare	$29.46
Rate for Payer: Hawaii Medical Service Association ABD	$25.00
Rate for Payer: Hawaii Medical Service Association Commercial	$33.48
Rate for Payer: Hawaii Medical Service Association Medicare	$26.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.25
Rate for Payer: Hawaii Western Management Group Commercial	$26.78
Rate for Payer: Health Management Network Commercial	$160.65
Rate for Payer: Humana Medicare	$26.78
Rate for Payer: Kaiser Permanente Commercial	$119.07
Rate for Payer: Kaiser Permanente Medicaid	$96.39
Rate for Payer: Kaiser Permanente Medicare	$26.78
Rate for Payer: MDX Hawaii PPO	$183.33
Rate for Payer: Ohana Health Plan Medicaid	$29.46
Rate for Payer: Ohana Health Plan Medicare	$26.78
Rate for Payer: UnitedHealthcare Medicaid	$25.00
Rate for Payer: UnitedHealthcare Medicare	$26.78
Rate for Payer: University Health Alliance Commercial	$46.77

HCHG ACCOM MONITORING ACUTE

Facility

$4,950.00

Hospital Charge Code	K0000012
Hospital Revenue Code	206
Min. Negotiated Rate	$4,207.50
Max. Negotiated Rate	$8,900.00
Rate for Payer: Cash Price	$3,217.50
Rate for Payer: Cash Price	$3,217.50
Rate for Payer: Hawaii Western Management Group Commercial	$8,900.00
Rate for Payer: Health Management Network Commercial	$4,207.50
Rate for Payer: MDX Hawaii PPO	$4,801.50
Rate for Payer: University Health Alliance Commercial	$6,369.00

HCHG ACCOM MONITORING OB

Facility

$4,950.00

Hospital Charge Code	K0000013
Hospital Revenue Code	206
Min. Negotiated Rate	$4,207.50
Max. Negotiated Rate	$8,900.00
Rate for Payer: Cash Price	$3,217.50
Rate for Payer: Cash Price	$3,217.50
Rate for Payer: Hawaii Western Management Group Commercial	$8,900.00
Rate for Payer: Health Management Network Commercial	$4,207.50
Rate for Payer: MDX Hawaii PPO	$4,801.50
Rate for Payer: University Health Alliance Commercial	$6,369.00

HCHG ACCOM MONITORING SEMI ACUTE

Facility

$4,950.00

Hospital Charge Code	K0000014
Hospital Revenue Code	206
Min. Negotiated Rate	$4,207.50
Max. Negotiated Rate	$8,900.00
Rate for Payer: Cash Price	$3,217.50
Rate for Payer: Cash Price	$3,217.50
Rate for Payer: Hawaii Western Management Group Commercial	$8,900.00
Rate for Payer: Health Management Network Commercial	$4,207.50
Rate for Payer: MDX Hawaii PPO	$4,801.50
Rate for Payer: University Health Alliance Commercial	$6,369.00

HCHG ACCOM NURSERY LEVEL 4

Facility

$4,400.00

Hospital Charge Code	K0000011
Hospital Revenue Code	174
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$4,268.00
Rate for Payer: Cash Price	$2,860.00
Rate for Payer: Cash Price	$2,860.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,250.00
Rate for Payer: Health Management Network Commercial	$3,740.00
Rate for Payer: MDX Hawaii PPO	$4,268.00
Rate for Payer: University Health Alliance Commercial	$1,875.00

HCHG ACCOM PRIVATE ACUTE

Facility

$2,750.00

Hospital Charge Code	K0000000
Hospital Revenue Code	111
Min. Negotiated Rate	$2,337.50
Max. Negotiated Rate	$7,250.00
Rate for Payer: Cash Price	$1,787.50
Rate for Payer: Cash Price	$1,787.50
Rate for Payer: Hawaii Western Management Group Commercial	$7,250.00
Rate for Payer: Health Management Network Commercial	$2,337.50
Rate for Payer: MDX Hawaii PPO	$2,667.50
Rate for Payer: University Health Alliance Commercial	$5,923.00

Know your out-of-pocket cost for care.

All Charges