Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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	$797.30
Max. Negotiated Rate	$909.86
Rate for Payer: Cash Price	$609.70
Rate for Payer: Health Management Network Commercial	$797.30
Rate for Payer: MDX Hawaii PPO	$909.86

HCHG CT CHEST W CONTR

Facility

$2,350.00

Service Code	HCPCS 71260
Hospital Charge Code	H3520118
Hospital Revenue Code	352
Min. Negotiated Rate	$1,997.50
Max. Negotiated Rate	$2,279.50
Rate for Payer: Cash Price	$1,527.50
Rate for Payer: Health Management Network Commercial	$1,997.50
Rate for Payer: MDX Hawaii PPO	$2,279.50

HCHG CT CHEST W CONTR

Facility

$2,350.00

Service Code	HCPCS 71260
Hospital Charge Code	H3520118
Hospital Revenue Code	352
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$2,279.50
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$1,527.50
Rate for Payer: Cash Price	$1,527.50
Rate for Payer: Devoted Health Medicare	$227.93
Rate for Payer: Hawaii Medical Service Association ABD	$232.90
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	$253.12
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$1,997.50
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$1,480.50
Rate for Payer: Kaiser Permanente Medicaid	$1,198.50
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$2,279.50
Rate for Payer: Ohana Health Plan Medicaid	$227.93
Rate for Payer: Ohana Health Plan Medicare	$207.21
Rate for Payer: UnitedHealthcare Medicaid	$232.90
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$686.18

HCHG CT CHEST WO CONTR

Facility

$1,763.00

Service Code	HCPCS 71250
Hospital Charge Code	H3520120
Hospital Revenue Code	352
Min. Negotiated Rate	$123.50
Max. Negotiated Rate	$1,710.11
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$1,145.95
Rate for Payer: Cash Price	$1,145.95
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$194.84
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	$211.43
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$1,498.55
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$1,110.69
Rate for Payer: Kaiser Permanente Medicaid	$899.13
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$1,710.11
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$194.84
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$502.27

HCHG CT CHEST WO CONTR

Facility

$1,763.00

Service Code	HCPCS 71250
Hospital Charge Code	H3520120
Hospital Revenue Code	352
Min. Negotiated Rate	$1,498.55
Max. Negotiated Rate	$1,710.11
Rate for Payer: Cash Price	$1,145.95
Rate for Payer: Health Management Network Commercial	$1,498.55
Rate for Payer: MDX Hawaii PPO	$1,710.11

HCHG CT CHEST W/WO CONTR

Facility

$2,350.00

Service Code	HCPCS 71270
Hospital Charge Code	H3520116
Hospital Revenue Code	352
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$2,279.50
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$1,527.50
Rate for Payer: Cash Price	$1,527.50
Rate for Payer: Devoted Health Medicare	$227.93
Rate for Payer: Hawaii Medical Service Association ABD	$291.10
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	$316.52
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$1,997.50
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$1,480.50
Rate for Payer: Kaiser Permanente Medicaid	$1,198.50
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$2,279.50
Rate for Payer: Ohana Health Plan Medicaid	$227.93
Rate for Payer: Ohana Health Plan Medicare	$207.21
Rate for Payer: UnitedHealthcare Medicaid	$291.10
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$799.87

HCHG CT CHEST W/WO CONTR

Facility

$2,350.00

Service Code	HCPCS 71270
Hospital Charge Code	H3520116
Hospital Revenue Code	352
Min. Negotiated Rate	$1,997.50
Max. Negotiated Rate	$2,279.50
Rate for Payer: Cash Price	$1,527.50
Rate for Payer: Health Management Network Commercial	$1,997.50
Rate for Payer: MDX Hawaii PPO	$2,279.50

HCHG CT C-SPINE EXT, WO CONTR

Facility

$1,539.00

Service Code	HCPCS 72125
Hospital Charge Code	H3520122
Hospital Revenue Code	352
Min. Negotiated Rate	$1,308.15
Max. Negotiated Rate	$1,492.83
Rate for Payer: Cash Price	$1,000.35
Rate for Payer: Health Management Network Commercial	$1,308.15
Rate for Payer: MDX Hawaii PPO	$1,492.83

HCHG CT C-SPINE EXT, WO CONTR

Facility

$1,539.00

Service Code	HCPCS 72125
Hospital Charge Code	H3520122
Hospital Revenue Code	352
Min. Negotiated Rate	$123.50
Max. Negotiated Rate	$1,492.83
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$1,000.35
Rate for Payer: Cash Price	$1,000.35
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$194.84
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	$211.43
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$1,308.15
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$969.57
Rate for Payer: Kaiser Permanente Medicaid	$784.89
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$1,492.83
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$194.84
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$502.27

HCHG CT C-SPINE W CONTRAST

Facility

$2,261.00

Service Code	HCPCS 72126
Hospital Charge Code	H3500235
Hospital Revenue Code	352
Min. Negotiated Rate	$232.90
Max. Negotiated Rate	$2,193.17
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$1,469.65
Rate for Payer: Cash Price	$1,469.65
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$232.90
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	$253.12
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$1,921.85
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,424.43
Rate for Payer: Kaiser Permanente Medicaid	$1,153.11
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$2,193.17
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$232.90
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$683.96

HCHG CT C-SPINE W CONTRAST

Facility

$2,261.00

Service Code	HCPCS 72126
Hospital Charge Code	H3500235
Hospital Revenue Code	352
Min. Negotiated Rate	$1,921.85
Max. Negotiated Rate	$2,193.17
Rate for Payer: Cash Price	$1,469.65
Rate for Payer: Health Management Network Commercial	$1,921.85
Rate for Payer: MDX Hawaii PPO	$2,193.17

HCHG CT DRAIN CHEST

Facility

$939.00

Service Code	HCPCS 75989
Hospital Charge Code	H3500136
Hospital Revenue Code	350
Min. Negotiated Rate	$103.94
Max. Negotiated Rate	$910.83
Rate for Payer: Cash Price	$610.35
Rate for Payer: Cash Price	$610.35
Rate for Payer: Hawaii Medical Service Association ABD	$103.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$112.58
Rate for Payer: Hawaii Western Management Group Commercial	$892.05
Rate for Payer: Health Management Network Commercial	$798.15
Rate for Payer: Kaiser Permanente Commercial	$591.57
Rate for Payer: Kaiser Permanente Medicaid	$478.89
Rate for Payer: MDX Hawaii PPO	$910.83
Rate for Payer: UnitedHealthcare Medicaid	$103.94
Rate for Payer: University Health Alliance Commercial	$317.64

HCHG CT DRAIN CHEST

Facility

$939.00

Service Code	HCPCS 75989
Hospital Charge Code	H3500136
Hospital Revenue Code	350
Min. Negotiated Rate	$798.15
Max. Negotiated Rate	$910.83
Rate for Payer: Cash Price	$610.35
Rate for Payer: Health Management Network Commercial	$798.15
Rate for Payer: MDX Hawaii PPO	$910.83

HCHG CT FACE W/O

Facility

$1,568.00

Service Code	HCPCS 70486
Hospital Charge Code	H3510102
Hospital Revenue Code	351
Min. Negotiated Rate	$123.50
Max. Negotiated Rate	$1,520.96
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$1,019.20
Rate for Payer: Cash Price	$1,019.20
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$155.53
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	$169.03
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$1,332.80
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$987.84
Rate for Payer: Kaiser Permanente Medicaid	$799.68
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$1,520.96
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$155.53
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$500.94

HCHG CT FACE W/O

Facility

$1,568.00

Service Code	HCPCS 70486
Hospital Charge Code	H3510102
Hospital Revenue Code	351
Min. Negotiated Rate	$1,332.80
Max. Negotiated Rate	$1,520.96
Rate for Payer: Cash Price	$1,019.20
Rate for Payer: Health Management Network Commercial	$1,332.80
Rate for Payer: MDX Hawaii PPO	$1,520.96

HCHG CT FOOT W/O CONTRAST

Facility

$1,730.00

Service Code	HCPCS 73700
Hospital Charge Code	H3520132
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 FOOT W/O CONTRAST

Facility

$1,730.00

Service Code	HCPCS 73700
Hospital Charge Code	H3520132
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 GUIDANCE PLCMT OF RT FIELDS

Facility

$501.00

Service Code	HCPCS 77014
Hospital Charge Code	H3500208
Hospital Revenue Code	333
Min. Negotiated Rate	$99.30
Max. Negotiated Rate	$485.97
Rate for Payer: Cash Price	$325.65
Rate for Payer: Cash Price	$325.65
Rate for Payer: Hawaii Medical Service Association ABD	$99.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$105.71
Rate for Payer: Hawaii Western Management Group Commercial	$475.95
Rate for Payer: Health Management Network Commercial	$425.85
Rate for Payer: Kaiser Permanente Commercial	$315.63
Rate for Payer: Kaiser Permanente Medicaid	$255.51
Rate for Payer: MDX Hawaii PPO	$485.97
Rate for Payer: UnitedHealthcare Medicaid	$99.30
Rate for Payer: University Health Alliance Commercial	$372.37

HCHG CT GUIDANCE PLCMT OF RT FIELDS

Facility

$501.00

Service Code	HCPCS 77014
Hospital Charge Code	H3500208
Hospital Revenue Code	333
Min. Negotiated Rate	$425.85
Max. Negotiated Rate	$485.97
Rate for Payer: Cash Price	$325.65
Rate for Payer: Health Management Network Commercial	$425.85
Rate for Payer: MDX Hawaii PPO	$485.97

HCHG CT GUIDE CATHET FLUID DRAINAGE

Facility

$3,028.00

Service Code	HCPCS 10030
Hospital Charge Code	H3610845
Hospital Revenue Code	361
Min. Negotiated Rate	$2,573.80
Max. Negotiated Rate	$2,937.16
Rate for Payer: Cash Price	$1,968.20
Rate for Payer: Health Management Network Commercial	$2,573.80
Rate for Payer: MDX Hawaii PPO	$2,937.16

HCHG CT GUIDE CATHET FLUID DRAINAGE

Facility

$3,028.00

Service Code	HCPCS 10030
Hospital Charge Code	H3610845
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$836.55
Rate for Payer: AlohaCare Medicare	$836.55
Rate for Payer: Cash Price	$1,968.20
Rate for Payer: Cash Price	$1,968.20
Rate for Payer: Cash Price	$1,968.20
Rate for Payer: Devoted Health Medicare	$920.21
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	$836.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$2,573.80
Rate for Payer: Humana Medicare	$836.55
Rate for Payer: Kaiser Permanente Commercial	$1,907.64
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$836.55
Rate for Payer: MDX Hawaii PPO	$2,937.16
Rate for Payer: Ohana Health Plan Medicaid	$920.21
Rate for Payer: Ohana Health Plan Medicare	$836.55
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$836.55
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG CT GUIDED NDL PLCMT

Facility

$1,854.00

Service Code	HCPCS 77012
Hospital Charge Code	H3500126
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 GUIDED NDL PLCMT

Facility

$1,854.00

Service Code	HCPCS 77012
Hospital Charge Code	H3500126
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 HEAD W CONTR

Facility

$2,173.00

Service Code	HCPCS 70460
Hospital Charge Code	H3510108
Hospital Revenue Code	351
Min. Negotiated Rate	$186.48
Max. Negotiated Rate	$2,107.81
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$1,412.45
Rate for Payer: Cash Price	$1,412.45
Rate for Payer: Devoted Health Medicare	$227.93
Rate for Payer: Hawaii Medical Service Association ABD	$186.48
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	$202.46
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$1,847.05
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$1,368.99
Rate for Payer: Kaiser Permanente Medicaid	$1,108.23
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$2,107.81
Rate for Payer: Ohana Health Plan Medicaid	$227.93
Rate for Payer: Ohana Health Plan Medicare	$207.21
Rate for Payer: UnitedHealthcare Medicaid	$186.48
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$591.56

HCHG CT HEAD W CONTR

Facility

$2,173.00

Service Code	HCPCS 70460
Hospital Charge Code	H3510108
Hospital Revenue Code	351
Min. Negotiated Rate	$1,847.05
Max. Negotiated Rate	$2,107.81
Rate for Payer: Cash Price	$1,412.45
Rate for Payer: Health Management Network Commercial	$1,847.05
Rate for Payer: MDX Hawaii PPO	$2,107.81

Know your out-of-pocket cost for care.

All Charges