Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG CT LOW EXTREM W/WO CONTR

Facility

$2,118.00

Service Code	HCPCS 73702
Hospital Charge Code	H3520144
Hospital Revenue Code	352
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$2,054.46
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$1,376.70
Rate for Payer: Cash Price	$1,376.70
Rate for Payer: Devoted Health Medicare	$227.93
Rate for Payer: Hawaii Medical Service Association ABD	$244.38
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	$265.57
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$1,800.30
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$1,334.34
Rate for Payer: Kaiser Permanente Medicaid	$1,080.18
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$2,054.46
Rate for Payer: Ohana Health Plan Medicaid	$227.93
Rate for Payer: Ohana Health Plan Medicare	$207.21
Rate for Payer: UnitedHealthcare Medicaid	$244.38
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$786.23

HCHG CT L-SPINE W CONTRAST

Facility

$2,261.00

Service Code	HCPCS 72132
Hospital Charge Code	H3500237
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 L-SPINE W CONTRAST

Facility

$2,261.00

Service Code	HCPCS 72132
Hospital Charge Code	H3500237
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 L-SPINE W/WO CONTR

Facility

$2,056.00

Service Code	HCPCS 72133
Hospital Charge Code	H3520148
Hospital Revenue Code	352
Min. Negotiated Rate	$1,747.60
Max. Negotiated Rate	$1,994.32
Rate for Payer: Cash Price	$1,336.40
Rate for Payer: Health Management Network Commercial	$1,747.60
Rate for Payer: MDX Hawaii PPO	$1,994.32

HCHG CT L-SPINE W/WO CONTR

Facility

$2,056.00

Service Code	HCPCS 72133
Hospital Charge Code	H3520148
Hospital Revenue Code	352
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$1,994.32
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$1,336.40
Rate for Payer: Cash Price	$1,336.40
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	$1,747.60
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$1,295.28
Rate for Payer: Kaiser Permanente Medicaid	$1,048.56
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$1,994.32
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	$789.62

HCHG CT LUNG CA SCREENING FU < 1 YEAR

Facility

$1,763.00

Service Code	HCPCS 71250
Hospital Charge Code	H3520237
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 LUNG CA SCREENING FU < 1 YEAR

Facility

$1,763.00

Service Code	HCPCS 71250
Hospital Charge Code	H3520237
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 MANDIBLE W/O

Facility

$1,568.00

Service Code	HCPCS 70486
Hospital Charge Code	H3510114
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 MANDIBLE W/O

Facility

$1,568.00

Service Code	HCPCS 70486
Hospital Charge Code	H3510114
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 MAXILLOFACIAL AREA W/CONTR

Facility

$1,811.00

Service Code	HCPCS 70487
Hospital Charge Code	H3510138
Hospital Revenue Code	351
Min. Negotiated Rate	$1,539.35
Max. Negotiated Rate	$1,756.67
Rate for Payer: Cash Price	$1,177.15
Rate for Payer: Health Management Network Commercial	$1,539.35
Rate for Payer: MDX Hawaii PPO	$1,756.67

HCHG CT MAXILLOFACIAL AREA W/CONTR

Facility

$1,811.00

Service Code	HCPCS 70487
Hospital Charge Code	H3510138
Hospital Revenue Code	351
Min. Negotiated Rate	$186.48
Max. Negotiated Rate	$1,756.67
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$1,177.15
Rate for Payer: Cash Price	$1,177.15
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	$1,539.35
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$1,140.93
Rate for Payer: Kaiser Permanente Medicaid	$923.61
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$1,756.67
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	$678.04

HCHG CT MAXILLOFACIAL W&WO

Facility

$1,811.00

Service Code	HCPCS 70488
Hospital Charge Code	H3510142
Hospital Revenue Code	351
Min. Negotiated Rate	$1,539.35
Max. Negotiated Rate	$1,756.67
Rate for Payer: Cash Price	$1,177.15
Rate for Payer: Health Management Network Commercial	$1,539.35
Rate for Payer: MDX Hawaii PPO	$1,756.67

HCHG CT MAXILLOFACIAL W&WO

Facility

$1,811.00

Service Code	HCPCS 70488
Hospital Charge Code	H3510142
Hospital Revenue Code	351
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$1,756.67
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$1,177.15
Rate for Payer: Cash Price	$1,177.15
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	$1,539.35
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$1,140.93
Rate for Payer: Kaiser Permanente Medicaid	$923.61
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$1,756.67
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	$804.23

HCHG CT NECK W CONTR

Facility

$1,811.00

Service Code	HCPCS 70491
Hospital Charge Code	H3510116
Hospital Revenue Code	351
Min. Negotiated Rate	$186.48
Max. Negotiated Rate	$1,756.67
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$1,177.15
Rate for Payer: Cash Price	$1,177.15
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	$1,539.35
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$1,140.93
Rate for Payer: Kaiser Permanente Medicaid	$923.61
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$1,756.67
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	$671.68

HCHG CT NECK W CONTR

Facility

$1,811.00

Service Code	HCPCS 70491
Hospital Charge Code	H3510116
Hospital Revenue Code	351
Min. Negotiated Rate	$1,539.35
Max. Negotiated Rate	$1,756.67
Rate for Payer: Cash Price	$1,177.15
Rate for Payer: Health Management Network Commercial	$1,539.35
Rate for Payer: MDX Hawaii PPO	$1,756.67

HCHG CT NECK WO CONTR

Facility

$1,811.00

Service Code	HCPCS 70490
Hospital Charge Code	H3510118
Hospital Revenue Code	351
Min. Negotiated Rate	$123.50
Max. Negotiated Rate	$1,756.67
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$1,177.15
Rate for Payer: Cash Price	$1,177.15
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	$1,539.35
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$1,140.93
Rate for Payer: Kaiser Permanente Medicaid	$923.61
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$1,756.67
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	$514.61

HCHG CT NECK WO CONTR

Facility

$1,811.00

Service Code	HCPCS 70490
Hospital Charge Code	H3510118
Hospital Revenue Code	351
Min. Negotiated Rate	$1,539.35
Max. Negotiated Rate	$1,756.67
Rate for Payer: Cash Price	$1,177.15
Rate for Payer: Health Management Network Commercial	$1,539.35
Rate for Payer: MDX Hawaii PPO	$1,756.67

HCHG CT ORBIT, SELLA, P FOSSA, OUT, MID, INNER EAR W/

Facility

$1,975.00

Service Code	HCPCS 70481
Hospital Charge Code	H3510136
Hospital Revenue Code	351
Min. Negotiated Rate	$186.48
Max. Negotiated Rate	$1,915.75
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$1,283.75
Rate for Payer: Cash Price	$1,283.75
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	$1,678.75
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$1,244.25
Rate for Payer: Kaiser Permanente Medicaid	$1,007.25
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$1,915.75
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	$702.69

HCHG CT ORBIT, SELLA, P FOSSA, OUT, MID, INNER EAR W/

Facility

$1,975.00

Service Code	HCPCS 70481
Hospital Charge Code	H3510136
Hospital Revenue Code	351
Min. Negotiated Rate	$1,678.75
Max. Negotiated Rate	$1,915.75
Rate for Payer: Cash Price	$1,283.75
Rate for Payer: Health Management Network Commercial	$1,678.75
Rate for Payer: MDX Hawaii PPO	$1,915.75

HCHG CT ORBITS WO CONTR

Facility

$1,600.00

Service Code	HCPCS 70480
Hospital Charge Code	H3510124
Hospital Revenue Code	351
Min. Negotiated Rate	$1,360.00
Max. Negotiated Rate	$1,552.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Health Management Network Commercial	$1,360.00
Rate for Payer: MDX Hawaii PPO	$1,552.00

HCHG CT ORBITS WO CONTR

Facility

$1,600.00

Service Code	HCPCS 70480
Hospital Charge Code	H3510124
Hospital Revenue Code	351
Min. Negotiated Rate	$123.50
Max. Negotiated Rate	$1,552.00
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Cash Price	$1,040.00
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	$1,360.00
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$1,008.00
Rate for Payer: Kaiser Permanente Medicaid	$816.00
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$1,552.00
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	$515.48

HCHG CT ORBITS W/WO CONTR

Facility

$1,958.00

Service Code	HCPCS 70482
Hospital Charge Code	H3510120
Hospital Revenue Code	351
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$1,899.26
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$1,272.70
Rate for Payer: Cash Price	$1,272.70
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	$1,664.30
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$1,233.54
Rate for Payer: Kaiser Permanente Medicaid	$998.58
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$1,899.26
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	$807.73

HCHG CT ORBITS W/WO CONTR

Facility

$1,958.00

Service Code	HCPCS 70482
Hospital Charge Code	H3510120
Hospital Revenue Code	351
Min. Negotiated Rate	$1,664.30
Max. Negotiated Rate	$1,899.26
Rate for Payer: Cash Price	$1,272.70
Rate for Payer: Health Management Network Commercial	$1,664.30
Rate for Payer: MDX Hawaii PPO	$1,899.26

HCHG CT ORB W CONTR

Facility

$1,975.00

Service Code	HCPCS 70481
Hospital Charge Code	H3510122
Hospital Revenue Code	351
Min. Negotiated Rate	$1,678.75
Max. Negotiated Rate	$1,915.75
Rate for Payer: Cash Price	$1,283.75
Rate for Payer: Health Management Network Commercial	$1,678.75
Rate for Payer: MDX Hawaii PPO	$1,915.75

HCHG CT ORB W CONTR

Facility

$1,975.00

Service Code	HCPCS 70481
Hospital Charge Code	H3510122
Hospital Revenue Code	351
Min. Negotiated Rate	$186.48
Max. Negotiated Rate	$1,915.75
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$1,283.75
Rate for Payer: Cash Price	$1,283.75
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	$1,678.75
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$1,244.25
Rate for Payer: Kaiser Permanente Medicaid	$1,007.25
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$1,915.75
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	$702.69

Know your out-of-pocket cost for care.

All Charges