Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG CONT MED PHYSIC PER WEEK OF THPY

Facility

$910.00

Service Code	HCPCS 77336
Hospital Charge Code	H3330114
Hospital Revenue Code	333
Min. Negotiated Rate	$773.50
Max. Negotiated Rate	$882.70
Rate for Payer: Cash Price	$591.50
Rate for Payer: Health Management Network Commercial	$773.50
Rate for Payer: MDX Hawaii PPO	$882.70

HCHG CONTRAST MEDIA

Facility

$13.00

Service Code	HCPCS A9579
Hospital Charge Code	H2540104
Hospital Revenue Code	250
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$8.45
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$8.19
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: UnitedHealthcare Medicaid	$7.80
Rate for Payer: University Health Alliance Commercial	$9.48

HCHG CONTRAST MEDIA

Facility

$13.00

Service Code	HCPCS A9579
Hospital Charge Code	H2540104
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$8.45
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: MDX Hawaii PPO	$12.61

HCHG CONTR INJ RAD EVAL EXIST GASTRO/DUODEN/JEJUNO/CECO TUBE

Facility

$795.00

Service Code	HCPCS 49465
Hospital Charge Code	H3600696
Hospital Revenue Code	360
Min. Negotiated Rate	$675.75
Max. Negotiated Rate	$771.15
Rate for Payer: Cash Price	$516.75
Rate for Payer: Health Management Network Commercial	$675.75
Rate for Payer: MDX Hawaii PPO	$771.15

HCHG CONTR INJ RAD EVAL EXIST GASTRO/DUODEN/JEJUNO/CECO TUBE

Facility

$795.00

Service Code	HCPCS 49465
Hospital Charge Code	H3600696
Hospital Revenue Code	360
Min. Negotiated Rate	$16.81
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$516.75
Rate for Payer: Cash Price	$516.75
Rate for Payer: Cash Price	$516.75
Rate for Payer: Devoted Health Medicare	$310.06
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	$281.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$675.75
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$500.85
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$771.15
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$16.81
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$579.48

HCHG CONTROL OROPHARYNG HEMORR SIMP

Facility

$1,919.00

Service Code	HCPCS 42960
Hospital Charge Code	H4500350
Hospital Revenue Code	450
Min. Negotiated Rate	$1,631.15
Max. Negotiated Rate	$1,861.43
Rate for Payer: Cash Price	$1,247.35
Rate for Payer: Health Management Network Commercial	$1,631.15
Rate for Payer: MDX Hawaii PPO	$1,861.43

HCHG CONTROL OROPHARYNG HEMORR SIMP

Facility

$1,919.00

Service Code	HCPCS 42960
Hospital Charge Code	H4500350
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$2,833.00
Rate for Payer: AlohaCare Medicaid	$637.13
Rate for Payer: AlohaCare Medicare	$637.13
Rate for Payer: Cash Price	$1,247.35
Rate for Payer: Cash Price	$1,247.35
Rate for Payer: Cash Price	$1,247.35
Rate for Payer: Devoted Health Medicare	$700.84
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	$637.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,823.05
Rate for Payer: Health Management Network Commercial	$1,631.15
Rate for Payer: Humana Medicare	$637.13
Rate for Payer: Kaiser Permanente Commercial	$1,208.97
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$637.13
Rate for Payer: MDX Hawaii PPO	$1,861.43
Rate for Payer: Ohana Health Plan Medicaid	$700.84
Rate for Payer: Ohana Health Plan Medicare	$637.13
Rate for Payer: UnitedHealthcare Medicare	$637.13
Rate for Payer: University Health Alliance Commercial	$1,398.76

HCHG COPPER-SERUM 90

Facility

$153.00

Service Code	HCPCS 82525
Hospital Charge Code	H3010414
Hospital Revenue Code	301
Min. Negotiated Rate	$12.41
Max. Negotiated Rate	$148.41
Rate for Payer: AlohaCare Medicaid	$12.41
Rate for Payer: AlohaCare Medicare	$12.41
Rate for Payer: Cash Price	$99.45
Rate for Payer: Cash Price	$99.45
Rate for Payer: Devoted Health Medicare	$13.65
Rate for Payer: Hawaii Medical Service Association ABD	$17.15
Rate for Payer: Hawaii Medical Service Association Commercial	$15.51
Rate for Payer: Hawaii Medical Service Association Medicare	$12.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.01
Rate for Payer: Hawaii Western Management Group Commercial	$12.41
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Humana Medicare	$12.41
Rate for Payer: Kaiser Permanente Commercial	$96.39
Rate for Payer: Kaiser Permanente Medicaid	$78.03
Rate for Payer: Kaiser Permanente Medicare	$12.41
Rate for Payer: MDX Hawaii PPO	$148.41
Rate for Payer: Ohana Health Plan Medicaid	$13.65
Rate for Payer: Ohana Health Plan Medicare	$12.41
Rate for Payer: UnitedHealthcare Medicaid	$17.15
Rate for Payer: UnitedHealthcare Medicare	$12.41
Rate for Payer: University Health Alliance Commercial	$32.08

HCHG COPPER-SERUM 90

Facility

$153.00

Service Code	HCPCS 82525
Hospital Charge Code	H3010414
Hospital Revenue Code	301
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$148.41
Rate for Payer: Cash Price	$99.45
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: MDX Hawaii PPO	$148.41

HCHG COPPER-URINE 90

Facility

$153.00

Service Code	HCPCS 82525
Hospital Charge Code	H3010416
Hospital Revenue Code	301
Min. Negotiated Rate	$12.41
Max. Negotiated Rate	$148.41
Rate for Payer: AlohaCare Medicaid	$12.41
Rate for Payer: AlohaCare Medicare	$12.41
Rate for Payer: Cash Price	$99.45
Rate for Payer: Cash Price	$99.45
Rate for Payer: Devoted Health Medicare	$13.65
Rate for Payer: Hawaii Medical Service Association ABD	$17.15
Rate for Payer: Hawaii Medical Service Association Commercial	$15.51
Rate for Payer: Hawaii Medical Service Association Medicare	$12.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.01
Rate for Payer: Hawaii Western Management Group Commercial	$12.41
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Humana Medicare	$12.41
Rate for Payer: Kaiser Permanente Commercial	$96.39
Rate for Payer: Kaiser Permanente Medicaid	$78.03
Rate for Payer: Kaiser Permanente Medicare	$12.41
Rate for Payer: MDX Hawaii PPO	$148.41
Rate for Payer: Ohana Health Plan Medicaid	$13.65
Rate for Payer: Ohana Health Plan Medicare	$12.41
Rate for Payer: UnitedHealthcare Medicaid	$17.15
Rate for Payer: UnitedHealthcare Medicare	$12.41
Rate for Payer: University Health Alliance Commercial	$32.08

HCHG COPPER-URINE 90

Facility

$153.00

Service Code	HCPCS 82525
Hospital Charge Code	H3010416
Hospital Revenue Code	301
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$148.41
Rate for Payer: Cash Price	$99.45
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: MDX Hawaii PPO	$148.41

HCHG CORD BLOOD GAS, ARTERIAL - 90

Facility

$180.00

Service Code	HCPCS 82803
Hospital Charge Code	K3010065
Hospital Revenue Code	301
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$117.00
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: MDX Hawaii PPO	$174.60

HCHG CORD BLOOD GAS, ARTERIAL - 90

Facility

$180.00

Service Code	HCPCS 82803
Hospital Charge Code	K3010065
Hospital Revenue Code	301
Min. Negotiated Rate	$26.07
Max. Negotiated Rate	$174.60
Rate for Payer: AlohaCare Medicaid	$26.07
Rate for Payer: AlohaCare Medicare	$26.07
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Devoted Health Medicare	$28.68
Rate for Payer: Hawaii Medical Service Association ABD	$26.74
Rate for Payer: Hawaii Medical Service Association Commercial	$32.59
Rate for Payer: Hawaii Medical Service Association Medicare	$26.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.08
Rate for Payer: Hawaii Western Management Group Commercial	$26.07
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: Humana Medicare	$26.07
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$91.80
Rate for Payer: Kaiser Permanente Medicare	$26.07
Rate for Payer: MDX Hawaii PPO	$174.60
Rate for Payer: Ohana Health Plan Medicaid	$28.68
Rate for Payer: Ohana Health Plan Medicare	$26.07
Rate for Payer: UnitedHealthcare Medicaid	$26.74
Rate for Payer: UnitedHealthcare Medicare	$26.07
Rate for Payer: University Health Alliance Commercial	$50.02

HCHG CORD BLOOD GAS, VENOUS - 90

Facility

$180.00

Service Code	HCPCS 82803
Hospital Charge Code	K3010066
Hospital Revenue Code	301
Min. Negotiated Rate	$26.07
Max. Negotiated Rate	$174.60
Rate for Payer: AlohaCare Medicaid	$26.07
Rate for Payer: AlohaCare Medicare	$26.07
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Devoted Health Medicare	$28.68
Rate for Payer: Hawaii Medical Service Association ABD	$26.74
Rate for Payer: Hawaii Medical Service Association Commercial	$32.59
Rate for Payer: Hawaii Medical Service Association Medicare	$26.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.08
Rate for Payer: Hawaii Western Management Group Commercial	$26.07
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: Humana Medicare	$26.07
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$91.80
Rate for Payer: Kaiser Permanente Medicare	$26.07
Rate for Payer: MDX Hawaii PPO	$174.60
Rate for Payer: Ohana Health Plan Medicaid	$28.68
Rate for Payer: Ohana Health Plan Medicare	$26.07
Rate for Payer: UnitedHealthcare Medicaid	$26.74
Rate for Payer: UnitedHealthcare Medicare	$26.07
Rate for Payer: University Health Alliance Commercial	$50.02

HCHG CORD BLOOD GAS, VENOUS - 90

Facility

$180.00

Service Code	HCPCS 82803
Hospital Charge Code	K3010066
Hospital Revenue Code	301
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$117.00
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: MDX Hawaii PPO	$174.60

HCHG CORE NDL BX LNG/MED PERQ

Facility

$8,126.00

Service Code	HCPCS 32408
Hospital Charge Code	H3610812
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$7,882.22
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$5,281.90
Rate for Payer: Cash Price	$5,281.90
Rate for Payer: Cash Price	$5,281.90
Rate for Payer: Devoted Health Medicare	$2,146.22
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	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Health Management Network Commercial	$6,907.10
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$5,119.38
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$7,882.22
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$5,160.40

HCHG CORE NDL BX LNG/MED PERQ

Facility

$8,126.00

Service Code	HCPCS 32408
Hospital Charge Code	H3610812
Hospital Revenue Code	361
Min. Negotiated Rate	$6,907.10
Max. Negotiated Rate	$7,882.22
Rate for Payer: Cash Price	$5,281.90
Rate for Payer: Health Management Network Commercial	$6,907.10
Rate for Payer: MDX Hawaii PPO	$7,882.22

HCHG CORISTOL FREE SERUM

Facility

$228.00

Service Code	HCPCS 82530
Hospital Charge Code	H3011335
Hospital Revenue Code	301
Min. Negotiated Rate	$193.80
Max. Negotiated Rate	$221.16
Rate for Payer: Cash Price	$148.20
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: MDX Hawaii PPO	$221.16

HCHG CORISTOL FREE SERUM

Facility

$228.00

Service Code	HCPCS 82530
Hospital Charge Code	H3011335
Hospital Revenue Code	301
Min. Negotiated Rate	$16.71
Max. Negotiated Rate	$221.16
Rate for Payer: AlohaCare Medicaid	$16.71
Rate for Payer: AlohaCare Medicare	$16.71
Rate for Payer: Cash Price	$148.20
Rate for Payer: Cash Price	$148.20
Rate for Payer: Devoted Health Medicare	$18.38
Rate for Payer: Hawaii Medical Service Association ABD	$23.10
Rate for Payer: Hawaii Medical Service Association Commercial	$20.89
Rate for Payer: Hawaii Medical Service Association Medicare	$16.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.26
Rate for Payer: Hawaii Western Management Group Commercial	$16.71
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: Humana Medicare	$16.71
Rate for Payer: Kaiser Permanente Commercial	$143.64
Rate for Payer: Kaiser Permanente Medicaid	$116.28
Rate for Payer: Kaiser Permanente Medicare	$16.71
Rate for Payer: MDX Hawaii PPO	$221.16
Rate for Payer: Ohana Health Plan Medicaid	$18.38
Rate for Payer: Ohana Health Plan Medicare	$16.71
Rate for Payer: UnitedHealthcare Medicaid	$23.10
Rate for Payer: UnitedHealthcare Medicare	$16.71
Rate for Payer: University Health Alliance Commercial	$43.20

HCHG CORTISOL FREE 24 HR URINE

Facility

$228.00

Service Code	HCPCS 82530
Hospital Charge Code	H3010418
Hospital Revenue Code	301
Min. Negotiated Rate	$16.71
Max. Negotiated Rate	$221.16
Rate for Payer: AlohaCare Medicaid	$16.71
Rate for Payer: AlohaCare Medicare	$16.71
Rate for Payer: Cash Price	$148.20
Rate for Payer: Cash Price	$148.20
Rate for Payer: Devoted Health Medicare	$18.38
Rate for Payer: Hawaii Medical Service Association ABD	$23.10
Rate for Payer: Hawaii Medical Service Association Commercial	$20.89
Rate for Payer: Hawaii Medical Service Association Medicare	$16.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.26
Rate for Payer: Hawaii Western Management Group Commercial	$16.71
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: Humana Medicare	$16.71
Rate for Payer: Kaiser Permanente Commercial	$143.64
Rate for Payer: Kaiser Permanente Medicaid	$116.28
Rate for Payer: Kaiser Permanente Medicare	$16.71
Rate for Payer: MDX Hawaii PPO	$221.16
Rate for Payer: Ohana Health Plan Medicaid	$18.38
Rate for Payer: Ohana Health Plan Medicare	$16.71
Rate for Payer: UnitedHealthcare Medicaid	$23.10
Rate for Payer: UnitedHealthcare Medicare	$16.71
Rate for Payer: University Health Alliance Commercial	$43.20

HCHG CORTISOL FREE 24 HR URINE

Facility

$228.00

Service Code	HCPCS 82530
Hospital Charge Code	H3010418
Hospital Revenue Code	301
Min. Negotiated Rate	$193.80
Max. Negotiated Rate	$221.16
Rate for Payer: Cash Price	$148.20
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: MDX Hawaii PPO	$221.16

HCHG CORTISOL SERUM/PLASMA RIA

Facility

$221.00

Service Code	HCPCS 82533
Hospital Charge Code	H3010420
Hospital Revenue Code	301
Min. Negotiated Rate	$16.30
Max. Negotiated Rate	$214.37
Rate for Payer: AlohaCare Medicaid	$16.30
Rate for Payer: AlohaCare Medicare	$16.30
Rate for Payer: Cash Price	$143.65
Rate for Payer: Cash Price	$143.65
Rate for Payer: Devoted Health Medicare	$17.93
Rate for Payer: Hawaii Medical Service Association ABD	$22.53
Rate for Payer: Hawaii Medical Service Association Commercial	$20.38
Rate for Payer: Hawaii Medical Service Association Medicare	$16.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.66
Rate for Payer: Hawaii Western Management Group Commercial	$16.30
Rate for Payer: Health Management Network Commercial	$187.85
Rate for Payer: Humana Medicare	$16.30
Rate for Payer: Kaiser Permanente Commercial	$139.23
Rate for Payer: Kaiser Permanente Medicaid	$112.71
Rate for Payer: Kaiser Permanente Medicare	$16.30
Rate for Payer: MDX Hawaii PPO	$214.37
Rate for Payer: Ohana Health Plan Medicaid	$17.93
Rate for Payer: Ohana Health Plan Medicare	$16.30
Rate for Payer: UnitedHealthcare Medicaid	$22.53
Rate for Payer: UnitedHealthcare Medicare	$16.30
Rate for Payer: University Health Alliance Commercial	$42.14

HCHG CORTISOL SERUM/PLASMA RIA

Facility

$221.00

Service Code	HCPCS 82533
Hospital Charge Code	H3010420
Hospital Revenue Code	301
Min. Negotiated Rate	$187.85
Max. Negotiated Rate	$214.37
Rate for Payer: Cash Price	$143.65
Rate for Payer: Health Management Network Commercial	$187.85
Rate for Payer: MDX Hawaii PPO	$214.37

HCHG CORTISONE SO

Facility

$223.00

Service Code	HCPCS 82542
Hospital Charge Code	K3010025
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 CORTISONE SO

Facility

$223.00

Service Code	HCPCS 82542
Hospital Charge Code	K3010025
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

Know your out-of-pocket cost for care.

All Charges