Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG CTA H&N C+ W/NONCONTRAST IMG

Facility

$1,876.00

Service Code	HCPCS 70471
Hospital Charge Code	H3500244
Hospital Revenue Code	350
Min. Negotiated Rate	$1,594.60
Max. Negotiated Rate	$1,819.72
Rate for Payer: Cash Price	$1,219.40
Rate for Payer: Health Management Network Commercial	$1,594.60
Rate for Payer: MDX Hawaii PPO	$1,819.72

HCHG CTA H&N C+ W/NONCONTRAST IMG

Facility

$1,876.00

Service Code	HCPCS 70471
Hospital Charge Code	H3500244
Hospital Revenue Code	350
Min. Negotiated Rate	$412.14
Max. Negotiated Rate	$1,819.72
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$1,219.40
Rate for Payer: Cash Price	$1,219.40
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$1,594.60
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,181.88
Rate for Payer: Kaiser Permanente Medicaid	$956.76
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$1,819.72
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$1,367.42

HCHG CTA LOW EXTREM W/WO CONTR

Facility

$2,279.00

Service Code	HCPCS 73706
Hospital Charge Code	H3520184
Hospital Revenue Code	352
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$2,210.63
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$1,481.35
Rate for Payer: Cash Price	$1,481.35
Rate for Payer: Devoted Health Medicare	$227.93
Rate for Payer: Hawaii Medical Service Association ABD	$284.73
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$207.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$388.44
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$1,937.15
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$1,435.77
Rate for Payer: Kaiser Permanente Medicaid	$1,162.29
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$2,210.63
Rate for Payer: Ohana Health Plan Medicaid	$227.93
Rate for Payer: Ohana Health Plan Medicare	$207.21
Rate for Payer: UnitedHealthcare Medicaid	$284.73
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$859.34

HCHG CTA LOW EXTREM W/WO CONTR

Facility

$2,279.00

Service Code	HCPCS 73706
Hospital Charge Code	H3520184
Hospital Revenue Code	352
Min. Negotiated Rate	$1,937.15
Max. Negotiated Rate	$2,210.63
Rate for Payer: Cash Price	$1,481.35
Rate for Payer: Health Management Network Commercial	$1,937.15
Rate for Payer: MDX Hawaii PPO	$2,210.63

HCHG CTA NECK W/WO CONTR

Facility

$2,477.00

Service Code	HCPCS 70498
Hospital Charge Code	H3510134
Hospital Revenue Code	351
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$2,402.69
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$1,610.05
Rate for Payer: Cash Price	$1,610.05
Rate for Payer: Devoted Health Medicare	$227.93
Rate for Payer: Hawaii Medical Service Association ABD	$279.09
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$207.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$380.02
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$2,105.45
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$1,560.51
Rate for Payer: Kaiser Permanente Medicaid	$1,263.27
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$2,402.69
Rate for Payer: Ohana Health Plan Medicaid	$227.93
Rate for Payer: Ohana Health Plan Medicare	$207.21
Rate for Payer: UnitedHealthcare Medicaid	$279.09
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$842.82

HCHG CTA NECK W/WO CONTR

Facility

$2,477.00

Service Code	HCPCS 70498
Hospital Charge Code	H3510134
Hospital Revenue Code	351
Min. Negotiated Rate	$2,105.45
Max. Negotiated Rate	$2,402.69
Rate for Payer: Cash Price	$1,610.05
Rate for Payer: Health Management Network Commercial	$2,105.45
Rate for Payer: MDX Hawaii PPO	$2,402.69

HCHG CT ANGIO HRT W/3D IMAGE

Facility

$1,508.00

Service Code	HCPCS 75574
Hospital Charge Code	H3500216
Hospital Revenue Code	352
Min. Negotiated Rate	$1,281.80
Max. Negotiated Rate	$1,462.76
Rate for Payer: Cash Price	$980.20
Rate for Payer: Health Management Network Commercial	$1,281.80
Rate for Payer: MDX Hawaii PPO	$1,462.76

HCHG CT ANGIO HRT W/3D IMAGE

Facility

$1,508.00

Service Code	HCPCS 75574
Hospital Charge Code	H3500216
Hospital Revenue Code	352
Min. Negotiated Rate	$187.39
Max. Negotiated Rate	$1,462.76
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$980.20
Rate for Payer: Cash Price	$980.20
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$187.39
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$299.78
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$1,281.80
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$950.04
Rate for Payer: Kaiser Permanente Medicaid	$769.08
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$1,462.76
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$187.39
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$800.09

HCHG CTA PELVIS W/WO CONTR

Facility

$2,283.00

Service Code	HCPCS 72191
Hospital Charge Code	H3520186
Hospital Revenue Code	352
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$2,214.51
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$1,483.95
Rate for Payer: Cash Price	$1,483.95
Rate for Payer: Devoted Health Medicare	$227.93
Rate for Payer: Hawaii Medical Service Association ABD	$311.76
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$207.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$424.97
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$1,940.55
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$1,438.29
Rate for Payer: Kaiser Permanente Medicaid	$1,164.33
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$2,214.51
Rate for Payer: Ohana Health Plan Medicaid	$227.93
Rate for Payer: Ohana Health Plan Medicare	$207.21
Rate for Payer: UnitedHealthcare Medicaid	$311.76
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$850.50

HCHG CTA PELVIS W/WO CONTR

Facility

$2,283.00

Service Code	HCPCS 72191
Hospital Charge Code	H3520186
Hospital Revenue Code	352
Min. Negotiated Rate	$1,940.55
Max. Negotiated Rate	$2,214.51
Rate for Payer: Cash Price	$1,483.95
Rate for Payer: Health Management Network Commercial	$1,940.55
Rate for Payer: MDX Hawaii PPO	$2,214.51

HCHG CT ARM LOWER W/O CONTRAST

Facility

$1,730.00

Service Code	HCPCS 73200
Hospital Charge Code	H3520112
Hospital Revenue Code	352
Min. Negotiated Rate	$1,470.50
Max. Negotiated Rate	$1,678.10
Rate for Payer: Cash Price	$1,124.50
Rate for Payer: Health Management Network Commercial	$1,470.50
Rate for Payer: MDX Hawaii PPO	$1,678.10

HCHG CT ARM LOWER W/O CONTRAST

Facility

$1,730.00

Service Code	HCPCS 73200
Hospital Charge Code	H3520112
Hospital Revenue Code	352
Min. Negotiated Rate	$123.50
Max. Negotiated Rate	$1,678.10
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$1,124.50
Rate for Payer: Cash Price	$1,124.50
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$163.33
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$123.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$177.42
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$1,470.50
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$1,089.90
Rate for Payer: Kaiser Permanente Medicaid	$882.30
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$1,678.10
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$163.33
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$497.32

HCHG CT ARM UPPER W/O CONTRAST

Facility

$1,730.00

Service Code	HCPCS 73200
Hospital Charge Code	H3520114
Hospital Revenue Code	352
Min. Negotiated Rate	$123.50
Max. Negotiated Rate	$1,678.10
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$1,124.50
Rate for Payer: Cash Price	$1,124.50
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$163.33
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$123.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$177.42
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$1,470.50
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$1,089.90
Rate for Payer: Kaiser Permanente Medicaid	$882.30
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$1,678.10
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$163.33
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$497.32

HCHG CT ARM UPPER W/O CONTRAST

Facility

$1,730.00

Service Code	HCPCS 73200
Hospital Charge Code	H3520114
Hospital Revenue Code	352
Min. Negotiated Rate	$1,470.50
Max. Negotiated Rate	$1,678.10
Rate for Payer: Cash Price	$1,124.50
Rate for Payer: Health Management Network Commercial	$1,470.50
Rate for Payer: MDX Hawaii PPO	$1,678.10

HCHG CTA UPP EXTREM W/WO CONTR

Facility

$2,071.00

Service Code	HCPCS 73206
Hospital Charge Code	H3520188
Hospital Revenue Code	352
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$2,008.87
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$1,346.15
Rate for Payer: Cash Price	$1,346.15
Rate for Payer: Devoted Health Medicare	$227.93
Rate for Payer: Hawaii Medical Service Association ABD	$284.73
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$207.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$388.44
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$1,760.35
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$1,304.73
Rate for Payer: Kaiser Permanente Medicaid	$1,056.21
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$2,008.87
Rate for Payer: Ohana Health Plan Medicaid	$227.93
Rate for Payer: Ohana Health Plan Medicare	$207.21
Rate for Payer: UnitedHealthcare Medicaid	$284.73
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$849.91

HCHG CTA UPP EXTREM W/WO CONTR

Facility

$2,071.00

Service Code	HCPCS 73206
Hospital Charge Code	H3520188
Hospital Revenue Code	352
Min. Negotiated Rate	$1,760.35
Max. Negotiated Rate	$2,008.87
Rate for Payer: Cash Price	$1,346.15
Rate for Payer: Health Management Network Commercial	$1,760.35
Rate for Payer: MDX Hawaii PPO	$2,008.87

HCHG CT BX ABDOMEN/PANCREAS

Facility

$1,854.00

Service Code	HCPCS 77012
Hospital Charge Code	H3500120
Hospital Revenue Code	350
Min. Negotiated Rate	$205.11
Max. Negotiated Rate	$1,798.38
Rate for Payer: Cash Price	$1,205.10
Rate for Payer: Cash Price	$1,205.10
Rate for Payer: Hawaii Medical Service Association ABD	$205.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$278.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,761.30
Rate for Payer: Health Management Network Commercial	$1,575.90
Rate for Payer: Kaiser Permanente Commercial	$1,168.02
Rate for Payer: Kaiser Permanente Medicaid	$945.54
Rate for Payer: MDX Hawaii PPO	$1,798.38
Rate for Payer: UnitedHealthcare Medicaid	$205.11
Rate for Payer: University Health Alliance Commercial	$535.82

HCHG CT BX ABDOMEN/PANCREAS

Facility

$1,854.00

Service Code	HCPCS 77012
Hospital Charge Code	H3500120
Hospital Revenue Code	350
Min. Negotiated Rate	$1,575.90
Max. Negotiated Rate	$1,798.38
Rate for Payer: Cash Price	$1,205.10
Rate for Payer: Health Management Network Commercial	$1,575.90
Rate for Payer: MDX Hawaii PPO	$1,798.38

HCHG CT BX MUSCLE/BONE

Facility

$1,854.00

Service Code	HCPCS 77012
Hospital Charge Code	H3500128
Hospital Revenue Code	350
Min. Negotiated Rate	$1,575.90
Max. Negotiated Rate	$1,798.38
Rate for Payer: Cash Price	$1,205.10
Rate for Payer: Health Management Network Commercial	$1,575.90
Rate for Payer: MDX Hawaii PPO	$1,798.38

HCHG CT BX MUSCLE/BONE

Facility

$1,854.00

Service Code	HCPCS 77012
Hospital Charge Code	H3500128
Hospital Revenue Code	350
Min. Negotiated Rate	$205.11
Max. Negotiated Rate	$1,798.38
Rate for Payer: Cash Price	$1,205.10
Rate for Payer: Cash Price	$1,205.10
Rate for Payer: Hawaii Medical Service Association ABD	$205.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$278.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,761.30
Rate for Payer: Health Management Network Commercial	$1,575.90
Rate for Payer: Kaiser Permanente Commercial	$1,168.02
Rate for Payer: Kaiser Permanente Medicaid	$945.54
Rate for Payer: MDX Hawaii PPO	$1,798.38
Rate for Payer: UnitedHealthcare Medicaid	$205.11
Rate for Payer: University Health Alliance Commercial	$535.82

HCHG CT BX PELVIS

Facility

$1,854.00

Service Code	HCPCS 77012
Hospital Charge Code	H3500132
Hospital Revenue Code	350
Min. Negotiated Rate	$1,575.90
Max. Negotiated Rate	$1,798.38
Rate for Payer: Cash Price	$1,205.10
Rate for Payer: Health Management Network Commercial	$1,575.90
Rate for Payer: MDX Hawaii PPO	$1,798.38

HCHG CT BX PELVIS

Facility

$1,854.00

Service Code	HCPCS 77012
Hospital Charge Code	H3500132
Hospital Revenue Code	350
Min. Negotiated Rate	$205.11
Max. Negotiated Rate	$1,798.38
Rate for Payer: Cash Price	$1,205.10
Rate for Payer: Cash Price	$1,205.10
Rate for Payer: Hawaii Medical Service Association ABD	$205.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$278.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,761.30
Rate for Payer: Health Management Network Commercial	$1,575.90
Rate for Payer: Kaiser Permanente Commercial	$1,168.02
Rate for Payer: Kaiser Permanente Medicaid	$945.54
Rate for Payer: MDX Hawaii PPO	$1,798.38
Rate for Payer: UnitedHealthcare Medicaid	$205.11
Rate for Payer: University Health Alliance Commercial	$535.82

HCHG CT CERE PRFU ALY C+WO CT/CTA

Facility

$1,035.00

Service Code	HCPCS 70473
Hospital Charge Code	H3500246
Hospital Revenue Code	350
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$1,003.95
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$672.75
Rate for Payer: Cash Price	$672.75
Rate for Payer: Devoted Health Medicare	$227.93
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$207.21
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$879.75
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$652.05
Rate for Payer: Kaiser Permanente Medicaid	$527.85
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$1,003.95
Rate for Payer: Ohana Health Plan Medicaid	$227.93
Rate for Payer: Ohana Health Plan Medicare	$207.21
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$754.41

HCHG CT CERE PRFU ALY C+WO CT/CTA

Facility

$1,035.00

Service Code	HCPCS 70473
Hospital Charge Code	H3500246
Hospital Revenue Code	350
Min. Negotiated Rate	$879.75
Max. Negotiated Rate	$1,003.95
Rate for Payer: Cash Price	$672.75
Rate for Payer: Health Management Network Commercial	$879.75
Rate for Payer: MDX Hawaii PPO	$1,003.95

HCHG CT CERE PRFU ALYS C+W/CT/CTA

Facility

$938.00

Service Code	HCPCS 70472
Hospital Charge Code	H3500245
Hospital Revenue Code	350
Min. Negotiated Rate	$478.38
Max. Negotiated Rate	$909.86
Rate for Payer: Cash Price	$609.70
Rate for Payer: Hawaii Western Management Group Commercial	$891.10
Rate for Payer: Health Management Network Commercial	$797.30
Rate for Payer: Kaiser Permanente Commercial	$590.94
Rate for Payer: Kaiser Permanente Medicaid	$478.38
Rate for Payer: MDX Hawaii PPO	$909.86
Rate for Payer: University Health Alliance Commercial	$683.71

Know your out-of-pocket cost for care.

All Charges