Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG CT PELVIS W CONTR

Facility

$2,173.00

Service Code	HCPCS 72193
Hospital Charge Code	H3520154
Hospital Revenue Code	352
Min. Negotiated Rate	$207.21
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	$225.48
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	$245.18
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	$225.48
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$680.15

HCHG CT PELVIS W CONTR

Facility

$2,173.00

Service Code	HCPCS 72193
Hospital Charge Code	H3520154
Hospital Revenue Code	352
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

HCHG CT PELVIS WO CONTR

Facility

$1,539.00

Service Code	HCPCS 72192
Hospital Charge Code	H3520156
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 PELVIS WO CONTR

Facility

$1,539.00

Service Code	HCPCS 72192
Hospital Charge Code	H3520156
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	$496.15

HCHG CT PELVIS W/WO CONTR

Facility

$2,350.00

Service Code	HCPCS 72194
Hospital Charge Code	H3520152
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	$279.37
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	$303.49
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	$279.37
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$784.55

HCHG CT PELVIS W/WO CONTR

Facility

$2,350.00

Service Code	HCPCS 72194
Hospital Charge Code	H3520152
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 PERFUSION W/CONTRAST

Facility

$1,972.00

Service Code	HCPCS 0042T
Hospital Charge Code	H3510137
Hospital Revenue Code	351
Min. Negotiated Rate	$1,676.20
Max. Negotiated Rate	$1,912.84
Rate for Payer: Cash Price	$1,281.80
Rate for Payer: Health Management Network Commercial	$1,676.20
Rate for Payer: MDX Hawaii PPO	$1,912.84

HCHG CT PERFUSION W/CONTRAST

Facility

$1,972.00

Service Code	HCPCS 0042T
Hospital Charge Code	H3510137
Hospital Revenue Code	351
Min. Negotiated Rate	$1,005.72
Max. Negotiated Rate	$1,912.84
Rate for Payer: Cash Price	$1,281.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.40
Rate for Payer: Health Management Network Commercial	$1,676.20
Rate for Payer: Kaiser Permanente Commercial	$1,242.36
Rate for Payer: Kaiser Permanente Medicaid	$1,005.72
Rate for Payer: MDX Hawaii PPO	$1,912.84
Rate for Payer: University Health Alliance Commercial	$1,437.39

HCHG CT SFT NECK W/ WO

Facility

$2,350.00

Service Code	HCPCS 70492
Hospital Charge Code	H3500150
Hospital Revenue Code	351
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 SFT NECK W/ WO

Facility

$2,350.00

Service Code	HCPCS 70492
Hospital Charge Code	H3500150
Hospital Revenue Code	351
Min. Negotiated Rate	$186.48
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	$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	$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	$186.48
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$807.15

HCHG CT SINUSES W/O

Facility

$1,568.00

Service Code	HCPCS 70486
Hospital Charge Code	H3510126
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 SINUSES W/O

Facility

$1,568.00

Service Code	HCPCS 70486
Hospital Charge Code	H3510126
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 SINUS/FACE W/ CONTRAST

Facility

$1,138.00

Service Code	HCPCS 70487
Hospital Charge Code	H3510140
Hospital Revenue Code	351
Min. Negotiated Rate	$967.30
Max. Negotiated Rate	$1,103.86
Rate for Payer: Cash Price	$739.70
Rate for Payer: Health Management Network Commercial	$967.30
Rate for Payer: MDX Hawaii PPO	$1,103.86

HCHG CT SINUS/FACE W/ CONTRAST

Facility

$1,138.00

Service Code	HCPCS 70487
Hospital Charge Code	H3510140
Hospital Revenue Code	351
Min. Negotiated Rate	$186.48
Max. Negotiated Rate	$1,103.86
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$739.70
Rate for Payer: Cash Price	$739.70
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	$967.30
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$716.94
Rate for Payer: Kaiser Permanente Medicaid	$580.38
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$1,103.86
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 TEMPORAL BONES, W CONTRAST

Facility

$1,975.00

Service Code	HCPCS 70481
Hospital Charge Code	H3510146
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 TEMPORAL BONES, W CONTRAST

Facility

$1,975.00

Service Code	HCPCS 70481
Hospital Charge Code	H3510146
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 TEMPORAL BONES, WO CONTR

Facility

$1,600.00

Service Code	HCPCS 70480
Hospital Charge Code	H3510130
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 TEMPORAL BONES, WO CONTR

Facility

$1,600.00

Service Code	HCPCS 70480
Hospital Charge Code	H3510130
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 T-SPINE EXT, WO CONTR

Facility

$1,539.00

Service Code	HCPCS 72128
Hospital Charge Code	H3520160
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 T-SPINE EXT, WO CONTR

Facility

$1,539.00

Service Code	HCPCS 72128
Hospital Charge Code	H3520160
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 T-SPINE W CONTRAST

Facility

$1,811.00

Service Code	HCPCS 72129
Hospital Charge Code	H3500236
Hospital Revenue Code	352
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 T-SPINE W CONTRAST

Facility

$1,811.00

Service Code	HCPCS 72129
Hospital Charge Code	H3500236
Hospital Revenue Code	352
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	$684.78

HCHG CT T-SPINE W/WO CONTR

Facility

$2,056.00

Service Code	HCPCS 72130
Hospital Charge Code	H3520164
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 T-SPINE W/WO CONTR

Facility

$2,056.00

Service Code	HCPCS 72130
Hospital Charge Code	H3520164
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 UPP EXTREM W CONTR

Facility

$2,261.00

Service Code	HCPCS 73201
Hospital Charge Code	H3520174
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

Know your out-of-pocket cost for care.

All Charges