Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG ECHO EXAM NEONAT HEAD

Facility

$591.00

Service Code	HCPCS 76506
Hospital Charge Code	H4020120
Hospital Revenue Code	402
Min. Negotiated Rate	$502.35
Max. Negotiated Rate	$573.27
Rate for Payer: Cash Price	$384.15
Rate for Payer: Health Management Network Commercial	$502.35
Rate for Payer: MDX Hawaii PPO	$573.27

HCHG ECHO EXAM NEONAT HEAD

Facility

$591.00

Service Code	HCPCS 76506
Hospital Charge Code	H4020120
Hospital Revenue Code	402
Min. Negotiated Rate	$46.98
Max. Negotiated Rate	$573.27
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$384.15
Rate for Payer: Cash Price	$384.15
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$46.98
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	$50.90
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$502.35
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$372.33
Rate for Payer: Kaiser Permanente Medicaid	$301.41
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$573.27
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$46.98
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$185.93

HCHG ECHO MYOCARDIAL STRAIN IMAGING

Facility

$207.00

Service Code	HCPCS 93356
Hospital Charge Code	H4800240
Hospital Revenue Code	480
Min. Negotiated Rate	$175.95
Max. Negotiated Rate	$200.79
Rate for Payer: Cash Price	$134.55
Rate for Payer: Health Management Network Commercial	$175.95
Rate for Payer: MDX Hawaii PPO	$200.79

HCHG ECHO MYOCARDIAL STRAIN IMAGING

Facility

$207.00

Service Code	HCPCS 93356
Hospital Charge Code	H4800240
Hospital Revenue Code	480
Min. Negotiated Rate	$11.42
Max. Negotiated Rate	$200.79
Rate for Payer: Cash Price	$134.55
Rate for Payer: Cash Price	$134.55
Rate for Payer: Hawaii Western Management Group Commercial	$196.65
Rate for Payer: Health Management Network Commercial	$175.95
Rate for Payer: Kaiser Permanente Commercial	$130.41
Rate for Payer: Kaiser Permanente Medicaid	$105.57
Rate for Payer: MDX Hawaii PPO	$200.79
Rate for Payer: UnitedHealthcare Medicaid	$11.42
Rate for Payer: University Health Alliance Commercial	$150.88

HCHG ECHO TRANSESOPHAGEAL

Facility

$3,040.00

Service Code	HCPCS 93312
Hospital Charge Code	H4800146
Hospital Revenue Code	480
Min. Negotiated Rate	$126.66
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$645.50
Rate for Payer: AlohaCare Medicare	$645.50
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Devoted Health Medicare	$710.05
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	$645.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$2,888.00
Rate for Payer: Health Management Network Commercial	$2,584.00
Rate for Payer: Humana Medicare	$645.50
Rate for Payer: Kaiser Permanente Commercial	$1,915.20
Rate for Payer: Kaiser Permanente Medicaid	$1,550.40
Rate for Payer: Kaiser Permanente Medicare	$645.50
Rate for Payer: MDX Hawaii PPO	$2,948.80
Rate for Payer: Ohana Health Plan Medicaid	$710.05
Rate for Payer: Ohana Health Plan Medicare	$645.50
Rate for Payer: UnitedHealthcare Medicaid	$126.66
Rate for Payer: UnitedHealthcare Medicare	$645.50
Rate for Payer: University Health Alliance Commercial	$2,215.86

HCHG ECHO TRANSESOPHAGEAL

Facility

$3,040.00

Service Code	HCPCS 93312
Hospital Charge Code	H4800146
Hospital Revenue Code	480
Min. Negotiated Rate	$2,584.00
Max. Negotiated Rate	$2,948.80
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Health Management Network Commercial	$2,584.00
Rate for Payer: MDX Hawaii PPO	$2,948.80

HCHG EGD CONTROL BLEEDING ANY

Facility

$8,203.00

Service Code	HCPCS 43255
Hospital Charge Code	H3610747
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$7,956.91
Rate for Payer: AlohaCare Medicaid	$2,266.89
Rate for Payer: AlohaCare Medicare	$2,266.89
Rate for Payer: Cash Price	$5,331.95
Rate for Payer: Cash Price	$5,331.95
Rate for Payer: Cash Price	$5,331.95
Rate for Payer: Devoted Health Medicare	$2,493.58
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	$2,266.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Health Management Network Commercial	$6,972.55
Rate for Payer: Humana Medicare	$2,266.89
Rate for Payer: Kaiser Permanente Commercial	$5,167.89
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,266.89
Rate for Payer: MDX Hawaii PPO	$7,956.91
Rate for Payer: Ohana Health Plan Medicaid	$2,493.58
Rate for Payer: Ohana Health Plan Medicare	$2,266.89
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,266.89
Rate for Payer: University Health Alliance Commercial	$5,160.40

HCHG EGD CONTROL BLEEDING ANY

Facility

$8,203.00

Service Code	HCPCS 43255
Hospital Charge Code	H3610747
Hospital Revenue Code	361
Min. Negotiated Rate	$6,972.55
Max. Negotiated Rate	$7,956.91
Rate for Payer: Cash Price	$5,331.95
Rate for Payer: Health Management Network Commercial	$6,972.55
Rate for Payer: MDX Hawaii PPO	$7,956.91

HCHG EGFR GENE ANALYSIS

Facility

$1,647.00

Service Code	HCPCS 81235
Hospital Charge Code	H3100227
Hospital Revenue Code	310
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$1,597.59
Rate for Payer: AlohaCare Medicaid	$324.58
Rate for Payer: AlohaCare Medicare	$324.58
Rate for Payer: Cash Price	$1,070.55
Rate for Payer: Cash Price	$1,070.55
Rate for Payer: Devoted Health Medicare	$357.04
Rate for Payer: Hawaii Medical Service Association Commercial	$405.73
Rate for Payer: Hawaii Medical Service Association Medicare	$324.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$323.80
Rate for Payer: Hawaii Western Management Group Commercial	$324.58
Rate for Payer: Health Management Network Commercial	$1,399.95
Rate for Payer: Humana Medicare	$324.58
Rate for Payer: Kaiser Permanente Commercial	$1,037.61
Rate for Payer: Kaiser Permanente Medicaid	$839.97
Rate for Payer: Kaiser Permanente Medicare	$324.58
Rate for Payer: MDX Hawaii PPO	$1,597.59
Rate for Payer: Ohana Health Plan Medicaid	$357.04
Rate for Payer: Ohana Health Plan Medicare	$324.58
Rate for Payer: UnitedHealthcare Medicaid	$135.00
Rate for Payer: UnitedHealthcare Medicare	$324.58
Rate for Payer: University Health Alliance Commercial	$1,200.50

HCHG EGFR GENE ANALYSIS

Facility

$1,647.00

Service Code	HCPCS 81235
Hospital Charge Code	H3100227
Hospital Revenue Code	310
Min. Negotiated Rate	$1,399.95
Max. Negotiated Rate	$1,597.59
Rate for Payer: Cash Price	$1,070.55
Rate for Payer: Health Management Network Commercial	$1,399.95
Rate for Payer: MDX Hawaii PPO	$1,597.59

HCHG EKG 12 LEADS, TRACING ONLY

Facility

$354.00

Service Code	HCPCS 93005
Hospital Charge Code	H7300107
Hospital Revenue Code	730
Min. Negotiated Rate	$300.90
Max. Negotiated Rate	$343.38
Rate for Payer: Cash Price	$230.10
Rate for Payer: Health Management Network Commercial	$300.90
Rate for Payer: MDX Hawaii PPO	$343.38

HCHG EKG 12 LEADS, TRACING ONLY

Facility

$354.00

Service Code	HCPCS 93005
Hospital Charge Code	H7300107
Hospital Revenue Code	730
Min. Negotiated Rate	$15.16
Max. Negotiated Rate	$343.38
Rate for Payer: AlohaCare Medicaid	$69.69
Rate for Payer: AlohaCare Medicare	$69.69
Rate for Payer: Cash Price	$230.10
Rate for Payer: Cash Price	$230.10
Rate for Payer: Devoted Health Medicare	$76.66
Rate for Payer: Hawaii Medical Service Association Commercial	$87.11
Rate for Payer: Hawaii Medical Service Association Medicare	$69.69
Rate for Payer: Hawaii Western Management Group Commercial	$336.30
Rate for Payer: Health Management Network Commercial	$300.90
Rate for Payer: Humana Medicare	$69.69
Rate for Payer: Kaiser Permanente Commercial	$223.02
Rate for Payer: Kaiser Permanente Medicaid	$180.54
Rate for Payer: Kaiser Permanente Medicare	$69.69
Rate for Payer: MDX Hawaii PPO	$343.38
Rate for Payer: Ohana Health Plan Medicaid	$76.66
Rate for Payer: Ohana Health Plan Medicare	$69.69
Rate for Payer: UnitedHealthcare Medicaid	$15.16
Rate for Payer: UnitedHealthcare Medicare	$69.69
Rate for Payer: University Health Alliance Commercial	$258.03

HCHG ELASTASE PANCREATIC FECAL QUANTITATIVE 90

Facility

$425.00

Service Code	HCPCS 82653
Hospital Charge Code	H3011707
Hospital Revenue Code	301
Min. Negotiated Rate	$13.78
Max. Negotiated Rate	$412.25
Rate for Payer: AlohaCare Medicaid	$22.97
Rate for Payer: AlohaCare Medicare	$22.97
Rate for Payer: Cash Price	$276.25
Rate for Payer: Cash Price	$276.25
Rate for Payer: Devoted Health Medicare	$25.27
Rate for Payer: Hawaii Medical Service Association ABD	$23.79
Rate for Payer: Hawaii Medical Service Association Commercial	$28.71
Rate for Payer: Hawaii Medical Service Association Medicare	$22.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.98
Rate for Payer: Hawaii Western Management Group Commercial	$22.97
Rate for Payer: Health Management Network Commercial	$361.25
Rate for Payer: Humana Medicare	$22.97
Rate for Payer: Kaiser Permanente Commercial	$267.75
Rate for Payer: Kaiser Permanente Medicaid	$216.75
Rate for Payer: Kaiser Permanente Medicare	$22.97
Rate for Payer: MDX Hawaii PPO	$412.25
Rate for Payer: Ohana Health Plan Medicaid	$25.27
Rate for Payer: Ohana Health Plan Medicare	$22.97
Rate for Payer: UnitedHealthcare Medicaid	$13.78
Rate for Payer: UnitedHealthcare Medicare	$22.97
Rate for Payer: University Health Alliance Commercial	$309.78

HCHG ELASTASE PANCREATIC FECAL QUANTITATIVE 90

Facility

$425.00

Service Code	HCPCS 82653
Hospital Charge Code	H3011707
Hospital Revenue Code	301
Min. Negotiated Rate	$361.25
Max. Negotiated Rate	$412.25
Rate for Payer: Cash Price	$276.25
Rate for Payer: Health Management Network Commercial	$361.25
Rate for Payer: MDX Hawaii PPO	$412.25

HCHG ELBOW (2 VIEWS)

Facility

$476.00

Service Code	HCPCS 73070
Hospital Charge Code	H3200320
Hospital Revenue Code	320
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$461.72
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$309.40
Rate for Payer: Cash Price	$309.40
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$17.04
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$102.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.60
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$299.88
Rate for Payer: Kaiser Permanente Medicaid	$242.76
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$461.72
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$17.04
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$55.57

HCHG ELBOW (2 VIEWS)

Facility

$476.00

Service Code	HCPCS 73070
Hospital Charge Code	H3200320
Hospital Revenue Code	320
Min. Negotiated Rate	$404.60
Max. Negotiated Rate	$461.72
Rate for Payer: Cash Price	$309.40
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: MDX Hawaii PPO	$461.72

HCHG ELBOW COMPL ETE- PORT, 2 VIEWS

Facility

$476.00

Service Code	HCPCS 73070
Hospital Charge Code	H3200324
Hospital Revenue Code	320
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$461.72
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$309.40
Rate for Payer: Cash Price	$309.40
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$17.04
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$102.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.60
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$299.88
Rate for Payer: Kaiser Permanente Medicaid	$242.76
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$461.72
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$17.04
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$55.57

HCHG ELBOW COMPL ETE- PORT, 2 VIEWS

Facility

$476.00

Service Code	HCPCS 73070
Hospital Charge Code	H3200324
Hospital Revenue Code	320
Min. Negotiated Rate	$404.60
Max. Negotiated Rate	$461.72
Rate for Payer: Cash Price	$309.40
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: MDX Hawaii PPO	$461.72

HCHG ELBOW MIN 3 VIEWS

Facility

$573.00

Service Code	HCPCS 73080
Hospital Charge Code	H3200326
Hospital Revenue Code	320
Min. Negotiated Rate	$487.05
Max. Negotiated Rate	$555.81
Rate for Payer: Cash Price	$372.45
Rate for Payer: Health Management Network Commercial	$487.05
Rate for Payer: MDX Hawaii PPO	$555.81

HCHG ELBOW MIN 3 VIEWS

Facility

$573.00

Service Code	HCPCS 73080
Hospital Charge Code	H3200326
Hospital Revenue Code	320
Min. Negotiated Rate	$18.84
Max. Negotiated Rate	$555.81
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$372.45
Rate for Payer: Cash Price	$372.45
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$18.84
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$102.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.64
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$487.05
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$360.99
Rate for Payer: Kaiser Permanente Medicaid	$292.23
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$555.81
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$18.84
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$68.41

HCHG ELECTROLYTE PANEL

Facility

$86.00

Service Code	HCPCS 80051
Hospital Charge Code	H3010568
Hospital Revenue Code	301
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$83.42
Rate for Payer: AlohaCare Medicaid	$7.01
Rate for Payer: AlohaCare Medicare	$7.01
Rate for Payer: Cash Price	$55.90
Rate for Payer: Cash Price	$55.90
Rate for Payer: Devoted Health Medicare	$7.71
Rate for Payer: Hawaii Medical Service Association ABD	$9.69
Rate for Payer: Hawaii Medical Service Association Commercial	$8.76
Rate for Payer: Hawaii Medical Service Association Medicare	$7.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.17
Rate for Payer: Hawaii Western Management Group Commercial	$7.01
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Humana Medicare	$7.01
Rate for Payer: Kaiser Permanente Commercial	$54.18
Rate for Payer: Kaiser Permanente Medicaid	$43.86
Rate for Payer: Kaiser Permanente Medicare	$7.01
Rate for Payer: MDX Hawaii PPO	$83.42
Rate for Payer: Ohana Health Plan Medicaid	$7.71
Rate for Payer: Ohana Health Plan Medicare	$7.01
Rate for Payer: UnitedHealthcare Medicaid	$9.69
Rate for Payer: UnitedHealthcare Medicare	$7.01
Rate for Payer: University Health Alliance Commercial	$18.13

HCHG ELECTROLYTE PANEL

Facility

$86.00

Service Code	HCPCS 80051
Hospital Charge Code	H3010568
Hospital Revenue Code	301
Min. Negotiated Rate	$73.10
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$55.90
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: MDX Hawaii PPO	$83.42

HCHG EMERGENCY FEE 1 NON-URGENT

Facility

$604.00

Service Code	HCPCS 99281
Hospital Charge Code	H4500416
Hospital Revenue Code	450
Min. Negotiated Rate	$513.40
Max. Negotiated Rate	$585.88
Rate for Payer: Cash Price	$392.60
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: MDX Hawaii PPO	$585.88

HCHG EMERGENCY FEE 1 NON-URGENT

Facility

$604.00

Service Code	HCPCS 99281
Hospital Charge Code	H4500416
Hospital Revenue Code	450
Min. Negotiated Rate	$99.62
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$140.00
Rate for Payer: AlohaCare Medicare	$99.62
Rate for Payer: Cash Price	$392.60
Rate for Payer: Cash Price	$392.60
Rate for Payer: Cash Price	$392.60
Rate for Payer: Cash Price	$392.60
Rate for Payer: Devoted Health Medicare	$109.58
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$99.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$573.80
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: Humana Medicare	$99.62
Rate for Payer: Kaiser Permanente Commercial	$380.52
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$99.62
Rate for Payer: MDX Hawaii PPO	$585.88
Rate for Payer: Ohana Health Plan Medicaid	$109.58
Rate for Payer: Ohana Health Plan Medicare	$99.62
Rate for Payer: UnitedHealthcare Medicare	$99.62
Rate for Payer: University Health Alliance Commercial	$440.26

HCHG EMERGENCY FEE 2 URGENT I

Facility

$1,004.00

Service Code	HCPCS 99282
Hospital Charge Code	H4500418
Hospital Revenue Code	450
Min. Negotiated Rate	$853.40
Max. Negotiated Rate	$973.88
Rate for Payer: Cash Price	$652.60
Rate for Payer: Health Management Network Commercial	$853.40
Rate for Payer: MDX Hawaii PPO	$973.88

Know your out-of-pocket cost for care.

All Charges