Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG CODE BLUE NURSERY

Facility

$1,285.00

Service Code	HCPCS 99465
Hospital Charge Code	H3600180
Hospital Revenue Code	480
Min. Negotiated Rate	$1,092.25
Max. Negotiated Rate	$1,246.45
Rate for Payer: Cash Price	$835.25
Rate for Payer: Health Management Network Commercial	$1,092.25
Rate for Payer: MDX Hawaii PPO	$1,246.45

HCHG COL CHROMOTOGRAPHY QUAL/QUAN

Facility

$223.00

Service Code	HCPCS 82542
Hospital Charge Code	H3011604
Hospital Revenue Code	301
Min. Negotiated Rate	$189.55
Max. Negotiated Rate	$216.31
Rate for Payer: Cash Price	$144.95
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: MDX Hawaii PPO	$216.31

HCHG COL CHROMOTOGRAPHY QUAL/QUAN

Facility

$223.00

Service Code	HCPCS 82542
Hospital Charge Code	H3011604
Hospital Revenue Code	301
Min. Negotiated Rate	$24.09
Max. Negotiated Rate	$216.31
Rate for Payer: AlohaCare Medicaid	$24.09
Rate for Payer: AlohaCare Medicare	$24.09
Rate for Payer: Cash Price	$144.95
Rate for Payer: Cash Price	$144.95
Rate for Payer: Devoted Health Medicare	$26.50
Rate for Payer: Hawaii Medical Service Association ABD	$24.96
Rate for Payer: Hawaii Medical Service Association Commercial	$30.11
Rate for Payer: Hawaii Medical Service Association Medicare	$24.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.21
Rate for Payer: Hawaii Western Management Group Commercial	$24.09
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: Humana Medicare	$24.09
Rate for Payer: Kaiser Permanente Commercial	$140.49
Rate for Payer: Kaiser Permanente Medicaid	$113.73
Rate for Payer: Kaiser Permanente Medicare	$24.09
Rate for Payer: MDX Hawaii PPO	$216.31
Rate for Payer: Ohana Health Plan Medicaid	$26.50
Rate for Payer: Ohana Health Plan Medicare	$24.09
Rate for Payer: UnitedHealthcare Medicaid	$24.96
Rate for Payer: UnitedHealthcare Medicare	$24.09
Rate for Payer: University Health Alliance Commercial	$46.68

HCHG COLD AGGLUTININS

Facility

$106.00

Service Code	HCPCS 86157
Hospital Charge Code	H3020436
Hospital Revenue Code	302
Min. Negotiated Rate	$90.10
Max. Negotiated Rate	$102.82
Rate for Payer: Cash Price	$68.90
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: MDX Hawaii PPO	$102.82

HCHG COLD AGGLUTININS

Facility

$106.00

Service Code	HCPCS 86157
Hospital Charge Code	H3020436
Hospital Revenue Code	302
Min. Negotiated Rate	$8.06
Max. Negotiated Rate	$102.82
Rate for Payer: AlohaCare Medicaid	$8.06
Rate for Payer: AlohaCare Medicare	$8.06
Rate for Payer: Cash Price	$68.90
Rate for Payer: Cash Price	$68.90
Rate for Payer: Devoted Health Medicare	$8.87
Rate for Payer: Hawaii Medical Service Association ABD	$11.14
Rate for Payer: Hawaii Medical Service Association Commercial	$10.07
Rate for Payer: Hawaii Medical Service Association Medicare	$8.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.70
Rate for Payer: Hawaii Western Management Group Commercial	$8.06
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: Humana Medicare	$8.06
Rate for Payer: Kaiser Permanente Commercial	$66.78
Rate for Payer: Kaiser Permanente Medicaid	$54.06
Rate for Payer: Kaiser Permanente Medicare	$8.06
Rate for Payer: MDX Hawaii PPO	$102.82
Rate for Payer: Ohana Health Plan Medicaid	$8.87
Rate for Payer: Ohana Health Plan Medicare	$8.06
Rate for Payer: UnitedHealthcare Medicaid	$11.14
Rate for Payer: UnitedHealthcare Medicare	$8.06
Rate for Payer: University Health Alliance Commercial	$20.85

HCHG COLD AGGLUTININ SCR SO

Facility

$92.00

Service Code	HCPCS 86156
Hospital Charge Code	K3000002
Hospital Revenue Code	300
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$89.24
Rate for Payer: AlohaCare Medicaid	$8.07
Rate for Payer: AlohaCare Medicare	$8.07
Rate for Payer: Cash Price	$59.80
Rate for Payer: Cash Price	$59.80
Rate for Payer: Devoted Health Medicare	$8.88
Rate for Payer: Hawaii Medical Service Association ABD	$9.26
Rate for Payer: Hawaii Medical Service Association Commercial	$10.09
Rate for Payer: Hawaii Medical Service Association Medicare	$8.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.72
Rate for Payer: Hawaii Western Management Group Commercial	$8.07
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Humana Medicare	$8.07
Rate for Payer: Kaiser Permanente Commercial	$57.96
Rate for Payer: Kaiser Permanente Medicaid	$46.92
Rate for Payer: Kaiser Permanente Medicare	$8.07
Rate for Payer: MDX Hawaii PPO	$89.24
Rate for Payer: Ohana Health Plan Medicaid	$8.88
Rate for Payer: Ohana Health Plan Medicare	$8.07
Rate for Payer: UnitedHealthcare Medicaid	$9.26
Rate for Payer: UnitedHealthcare Medicare	$8.07
Rate for Payer: University Health Alliance Commercial	$17.32

HCHG COLD AGGLUTININ SCR SO

Facility

$92.00

Service Code	HCPCS 86156
Hospital Charge Code	K3000002
Hospital Revenue Code	300
Min. Negotiated Rate	$78.20
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$59.80
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: MDX Hawaii PPO	$89.24

HCHG COLLECT BLD VIA EST CENTRAL/PERIPHERAL CATH VENOUS

Facility

$320.00

Service Code	HCPCS 36592
Hospital Charge Code	H4500900
Hospital Revenue Code	450
Min. Negotiated Rate	$272.00
Max. Negotiated Rate	$310.40
Rate for Payer: Cash Price	$208.00
Rate for Payer: Health Management Network Commercial	$272.00
Rate for Payer: MDX Hawaii PPO	$310.40

HCHG COLLECT BLD VIA EST CENTRAL/PERIPHERAL CATH VENOUS

Facility

$320.00

Service Code	HCPCS 36592
Hospital Charge Code	H4500900
Hospital Revenue Code	450
Min. Negotiated Rate	$157.18
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$208.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$304.00
Rate for Payer: Health Management Network Commercial	$272.00
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$201.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$310.40
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$233.25

HCHG COLLECT BLOOD FROM PICC

Facility

$320.00

Service Code	HCPCS 36592
Hospital Charge Code	H3001111
Hospital Revenue Code	300
Min. Negotiated Rate	$272.00
Max. Negotiated Rate	$310.40
Rate for Payer: Cash Price	$208.00
Rate for Payer: Health Management Network Commercial	$272.00
Rate for Payer: MDX Hawaii PPO	$310.40

HCHG COLLECT BLOOD FROM PICC

Facility

$320.00

Service Code	HCPCS 36592
Hospital Charge Code	H3001111
Hospital Revenue Code	300
Min. Negotiated Rate	$15.71
Max. Negotiated Rate	$310.40
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$208.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association Commercial	$196.47
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Western Management Group Commercial	$304.00
Rate for Payer: Health Management Network Commercial	$272.00
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$201.60
Rate for Payer: Kaiser Permanente Medicaid	$163.20
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$310.40
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicaid	$15.71
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$233.25

HCHG COLLECT BLOOD VENOUS DEVICE

Facility

$360.00

Service Code	HCPCS 36591
Hospital Charge Code	H3600675
Hospital Revenue Code	300
Min. Negotiated Rate	$306.00
Max. Negotiated Rate	$349.20
Rate for Payer: Cash Price	$234.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: MDX Hawaii PPO	$349.20

HCHG COLLECT BLOOD VENOUS DEVICE

Facility

$360.00

Service Code	HCPCS 36591
Hospital Charge Code	H3600675
Hospital Revenue Code	300
Min. Negotiated Rate	$12.68
Max. Negotiated Rate	$349.20
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association Commercial	$196.47
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Western Management Group Commercial	$342.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$226.80
Rate for Payer: Kaiser Permanente Medicaid	$183.60
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$349.20
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicaid	$12.68
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$262.40

HCHG COLLECTION VENOUS BLD, VENIPUNCTURE

Facility

$64.00

Service Code	HCPCS 36415
Hospital Charge Code	H3001106
Hospital Revenue Code	300
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$62.08
Rate for Payer: AlohaCare Medicaid	$9.34
Rate for Payer: AlohaCare Medicare	$9.34
Rate for Payer: Cash Price	$41.60
Rate for Payer: Cash Price	$41.60
Rate for Payer: Devoted Health Medicare	$10.27
Rate for Payer: Hawaii Medical Service Association Commercial	$11.68
Rate for Payer: Hawaii Medical Service Association Medicare	$9.34
Rate for Payer: Hawaii Western Management Group Commercial	$60.80
Rate for Payer: Health Management Network Commercial	$54.40
Rate for Payer: Humana Medicare	$9.34
Rate for Payer: Kaiser Permanente Commercial	$40.32
Rate for Payer: Kaiser Permanente Medicaid	$32.64
Rate for Payer: Kaiser Permanente Medicare	$9.34
Rate for Payer: MDX Hawaii PPO	$62.08
Rate for Payer: Ohana Health Plan Medicaid	$10.27
Rate for Payer: Ohana Health Plan Medicare	$9.34
Rate for Payer: UnitedHealthcare Medicaid	$3.00
Rate for Payer: UnitedHealthcare Medicare	$9.34
Rate for Payer: University Health Alliance Commercial	$46.65

HCHG COLLECTION VENOUS BLD, VENIPUNCTURE

Facility

$64.00

Service Code	HCPCS 36415
Hospital Charge Code	H3001106
Hospital Revenue Code	300
Min. Negotiated Rate	$54.40
Max. Negotiated Rate	$62.08
Rate for Payer: Cash Price	$41.60
Rate for Payer: Health Management Network Commercial	$54.40
Rate for Payer: MDX Hawaii PPO	$62.08

HCHG COLONOSCOPY - DIAGNOSTIC

Facility

$2,716.00

Service Code	HCPCS 45378
Hospital Charge Code	H4501101
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$1,098.60
Rate for Payer: AlohaCare Medicare	$1,098.60
Rate for Payer: Cash Price	$1,765.40
Rate for Payer: Cash Price	$1,765.40
Rate for Payer: Cash Price	$1,765.40
Rate for Payer: Devoted Health Medicare	$1,208.46
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,098.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$2,580.20
Rate for Payer: Health Management Network Commercial	$2,308.60
Rate for Payer: Humana Medicare	$1,098.60
Rate for Payer: Kaiser Permanente Commercial	$1,711.08
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,098.60
Rate for Payer: MDX Hawaii PPO	$2,634.52
Rate for Payer: Ohana Health Plan Medicaid	$1,208.46
Rate for Payer: Ohana Health Plan Medicare	$1,098.60
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,098.60
Rate for Payer: University Health Alliance Commercial	$5,160.40

HCHG COLONOSCOPY - DIAGNOSTIC

Facility

$2,716.00

Service Code	HCPCS 45378
Hospital Charge Code	H4501101
Hospital Revenue Code	450
Min. Negotiated Rate	$2,308.60
Max. Negotiated Rate	$2,634.52
Rate for Payer: Cash Price	$1,765.40
Rate for Payer: Health Management Network Commercial	$2,308.60
Rate for Payer: MDX Hawaii PPO	$2,634.52

HCHG COLOR FLOW DOPPLER DUR ECHO

Facility

$455.00

Service Code	HCPCS 93325
Hospital Charge Code	H4800114
Hospital Revenue Code	480
Min. Negotiated Rate	$40.70
Max. Negotiated Rate	$441.35
Rate for Payer: Cash Price	$295.75
Rate for Payer: Cash Price	$295.75
Rate for Payer: Hawaii Medical Service Association ABD	$96.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$40.70
Rate for Payer: Hawaii Western Management Group Commercial	$432.25
Rate for Payer: Health Management Network Commercial	$386.75
Rate for Payer: Kaiser Permanente Commercial	$286.65
Rate for Payer: Kaiser Permanente Medicaid	$232.05
Rate for Payer: MDX Hawaii PPO	$441.35
Rate for Payer: UnitedHealthcare Medicaid	$96.84
Rate for Payer: University Health Alliance Commercial	$331.65

HCHG COLOR FLOW DOPPLER DUR ECHO

Facility

$455.00

Service Code	HCPCS 93325
Hospital Charge Code	H4800114
Hospital Revenue Code	480
Min. Negotiated Rate	$386.75
Max. Negotiated Rate	$441.35
Rate for Payer: Cash Price	$295.75
Rate for Payer: Health Management Network Commercial	$386.75
Rate for Payer: MDX Hawaii PPO	$441.35

HCHG COMPATABILITY, IMMED SPIN TQ

Facility

$399.00

Service Code	HCPCS 86920
Hospital Charge Code	H3000696
Hospital Revenue Code	300
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$387.03
Rate for Payer: AlohaCare Medicaid	$201.27
Rate for Payer: AlohaCare Medicare	$201.27
Rate for Payer: Cash Price	$259.35
Rate for Payer: Cash Price	$259.35
Rate for Payer: Devoted Health Medicare	$221.40
Rate for Payer: Hawaii Medical Service Association ABD	$20.80
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	$27.97
Rate for Payer: Hawaii Western Management Group Commercial	$201.27
Rate for Payer: Health Management Network Commercial	$339.15
Rate for Payer: Humana Medicare	$201.27
Rate for Payer: Kaiser Permanente Commercial	$251.37
Rate for Payer: Kaiser Permanente Medicaid	$203.49
Rate for Payer: Kaiser Permanente Medicare	$201.27
Rate for Payer: MDX Hawaii PPO	$387.03
Rate for Payer: Ohana Health Plan Medicaid	$221.40
Rate for Payer: Ohana Health Plan Medicare	$201.27
Rate for Payer: UnitedHealthcare Medicaid	$20.80
Rate for Payer: UnitedHealthcare Medicare	$201.27
Rate for Payer: University Health Alliance Commercial	$42.35

HCHG COMPATABILITY, IMMED SPIN TQ

Facility

$399.00

Service Code	HCPCS 86920
Hospital Charge Code	H3000696
Hospital Revenue Code	300
Min. Negotiated Rate	$339.15
Max. Negotiated Rate	$387.03
Rate for Payer: Cash Price	$259.35
Rate for Payer: Health Management Network Commercial	$339.15
Rate for Payer: MDX Hawaii PPO	$387.03

HCHG COMPATIB AHG 1 UNIT

Facility

$375.00

Service Code	HCPCS 86922
Hospital Charge Code	K3000004
Hospital Revenue Code	300
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$363.75
Rate for Payer: Cash Price	$243.75
Rate for Payer: Health Management Network Commercial	$318.75
Rate for Payer: MDX Hawaii PPO	$363.75

HCHG COMPATIB AHG 1 UNIT

Facility

$375.00

Service Code	HCPCS 86922
Hospital Charge Code	K3000004
Hospital Revenue Code	300
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$363.75
Rate for Payer: AlohaCare Medicaid	$201.27
Rate for Payer: AlohaCare Medicare	$201.27
Rate for Payer: Cash Price	$243.75
Rate for Payer: Cash Price	$243.75
Rate for Payer: Devoted Health Medicare	$221.40
Rate for Payer: Hawaii Medical Service Association ABD	$20.80
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	$27.97
Rate for Payer: Hawaii Western Management Group Commercial	$201.27
Rate for Payer: Health Management Network Commercial	$318.75
Rate for Payer: Humana Medicare	$201.27
Rate for Payer: Kaiser Permanente Commercial	$236.25
Rate for Payer: Kaiser Permanente Medicaid	$191.25
Rate for Payer: Kaiser Permanente Medicare	$201.27
Rate for Payer: MDX Hawaii PPO	$363.75
Rate for Payer: Ohana Health Plan Medicaid	$221.40
Rate for Payer: Ohana Health Plan Medicare	$201.27
Rate for Payer: UnitedHealthcare Medicaid	$20.80
Rate for Payer: UnitedHealthcare Medicare	$201.27
Rate for Payer: University Health Alliance Commercial	$273.34

HCHG COMPATIB AHG 1 UNIT

Facility

$375.00

Service Code	HCPCS 86922
Hospital Charge Code	H3900130
Hospital Revenue Code	302
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$363.75
Rate for Payer: Cash Price	$243.75
Rate for Payer: Health Management Network Commercial	$318.75
Rate for Payer: MDX Hawaii PPO	$363.75

HCHG COMPATIB AHG 1 UNIT

Facility

$375.00

Service Code	HCPCS 86922
Hospital Charge Code	H3900130
Hospital Revenue Code	302
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$363.75
Rate for Payer: AlohaCare Medicaid	$201.27
Rate for Payer: AlohaCare Medicare	$201.27
Rate for Payer: Cash Price	$243.75
Rate for Payer: Cash Price	$243.75
Rate for Payer: Devoted Health Medicare	$221.40
Rate for Payer: Hawaii Medical Service Association ABD	$20.80
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	$27.97
Rate for Payer: Hawaii Western Management Group Commercial	$201.27
Rate for Payer: Health Management Network Commercial	$318.75
Rate for Payer: Humana Medicare	$201.27
Rate for Payer: Kaiser Permanente Commercial	$236.25
Rate for Payer: Kaiser Permanente Medicaid	$191.25
Rate for Payer: Kaiser Permanente Medicare	$201.27
Rate for Payer: MDX Hawaii PPO	$363.75
Rate for Payer: Ohana Health Plan Medicaid	$221.40
Rate for Payer: Ohana Health Plan Medicare	$201.27
Rate for Payer: UnitedHealthcare Medicaid	$20.80
Rate for Payer: UnitedHealthcare Medicare	$201.27
Rate for Payer: University Health Alliance Commercial	$273.34

Know your out-of-pocket cost for care.

All Charges